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Client Information Request Form


Client Name

Phone Number

Address

Date

12-13-2017

City, State, Zip

,

Expedite Request ($100 fee)

Yes, No

Email Address

Select Service

Help me choose

Who refered you to us?



Organization Information:

*This is the name, phone number, etc that will appear on your documents.

Business Name    Business Phone   Business Website Not Yet, None     

Is the organization a Church? Yes, No

Business Address 
City, State Zip       ,
Do you have an EIN already? Yes, No         

Director and Officer Details:

Please provide the names, addresses, and actual or proposed compensations for the your board of directors.

A 501(c)(3) organization is required to have a minimum of three (3) board members, preferably not related by blood or marriage (for example - if husband & wife are both board members, you must add three (3) people who are NOT related to the husband and/or wife).

You must have an odd number of board members.

Name

Title Address Compensation/Salary

1)   

   


,

    Volunteer Paid

2)   

   


,

    Volunteer Paid

3)   

   


,

    Volunteer Paid

4)   

   


,

    Volunteer Paid

5)   

   


,

    Volunteer Paid

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For each of your directors and officers, please provide (See chart below):

a.           their qualifications (i.e. education, experience) ( 75 minimum characters)
b.           average hours worked or volunteered per week
c.            duties performed for the organization. ( 75 minimum characters)

Name

Qualifications

Avg. Hours WEEKLY

Duties

Example

Aretha Olivarez

Nonprofit Consultant for 12 years

Her duties will be to solicit volunteers, conduct fundraising activities, and support in various areas as needed.

1) 



2) 



3) 



4) 



5) 



Are any of your board of directors related to each other?

Yes, No
Please identify the individuals and explain the relationship.

1) is the of

Add Another Relation

Questionnaire: Please tell us about your Non-Profit Organization

How often and where will you conduct your program/services? Please provide days of the week, times, and locations. 



What activities will you conduct under the program/services? Explain and give specific descriptions.



Is your program or service open to the public? 

Yes, No


How will people find out about your services?



Where and how do you anticipate getting income for this organization?




What date did your organization start or plan to start?



What goals have you or will you achieved with your Non-Profit Organization?



Complete the following Corporation Budget Projection form

Select if your corporation has:


Corporation Budget Projection

For purposes of this form, years in existence refers to completed tax years. Current completed tax year: 2016


Revenue:
Contributions/Grants$ $ $ $
Tithes & Offerings$ $ $ $
Special Offerings$ $ $ $
Total revenue
Expenses:
Compensation to Board Members$ $ $ $
Other Salary$ $ $ $
Advertising and Promotion$ $ $ $
Bank Fees and Charges$ $ $ $
Books and Tapes$ $ $ $
Children's Church$ $ $ $
Donations to Clients$ $ $ $
Insurance$ $ $ $
Legal Fees$ $ $ $
License & Permits$ $ $ $
Office Supplies$ $ $ $
Postage and Shipping Costs$ $ $ $
Professional Fees$ $ $ $
Rental Equiptment$ $ $ $
Rent/Mortgage$ $ $ $
Fundraising$ $ $ $
Taxes - Filing Fees$ $ $ $
Telephone$ $ $ $
Travel, Meals, & Lodging$ $ $ $
Utilities$ $ $ $
Miscellaneous$ $ $ $
Total expense

Please list all your Non-Profit Organization's assets and values below. (Exp. Vehicles, office/church equipment, land, office/church furniture, etc.)

AssetNet Value
$
$
$
$
$
View/Add More





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