Required fields are marked with
*
.
General Church Information
Church Name:
*
Mailing Address:
*
City:
*
State / Province:
*
Postal Code:
*
Country:
select
USA
Canada
Time Zone:
select
Eastern -5
Central -6
Mountain -7
Pacific -8
Alaska -9
Hawaii -10
Guam +10
GMT +1
GMT +2
GMT +3
GMT +4
GMT +5:30
GMT -3
GMT +7
Church Contact Information
This information will be used by
church members
to contact the church if they have questions.
Phone:
*
Phone Ext:
Website:
*
Email:
*
Primary Contact Information
This information will be used by
High Ground Solutions, Inc.
if we have questions.
A confirmation email will be sent to the Primary Contact's email address listed below.
First Name:
*
Middle Name:
Last Name:
*
Email:
*
Email (Confirm):
*
Phone:
*
Phone Type:
select
Cell
Home
Work
Other Information
Ordered By:
*
P.O. #:
Sales Rep:
*
Servant Keeper Cust. ID:
*
Your customer ID is on your invoice, and can also be found in Administrator under “HELP” – “ABOUT”
Promo Code:
Special Contact Instructions:
(255 character limit)