MINISTRY ADVANTAGE NON-PROFIT APPLICATION Step 1 of 7 14% ORGANIZATION SECTIONOrganization Name:Mailing Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Name First Last PhoneEmail Website Denomination (If Applicable):Average Weekly Attendance #:Date Incorporated: FEIN: PROPERTY SECTIONMeeting Location Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Building Owned by Organization:YesNoYear ConstructedSquare Footage Occupied:Church Personal Property Amount:Is Church Property Stored at Meeting Address Above?YesNo AUTOMOBILE SECTIONDoes The Organization Own An Automobile?YesNoYear:Make:Model:VIN #:Seating Capacity:Coverage Level Requested:Full CoverageLiability Only TRAILER SECTIONDoes The Organization Own A Trailer?YesNoYear:Make:Model:VIN #:Is Anything Being Stored Inside The Trailer?YesNo(If yes, please complete section below) If Yes, Please Estimate Contents Value: DRIVER SECTION DriversEmployee NameDOB Drivers License #Add driverRemove driver(Complete This Section Only If your Organization Owns An Automobile And / Or Trailer) WORKERS COMPENSATION SECTIONDoes The Organization Have Employees?YesNo(If yes, please complete section below)Total Number of Employees?Number of Pay Periods: Bi-Weekly Bi-Monthly Annual WorkersEmployee NameFull Time/Part TimeJob TitleAnnual Payroll(including auto & housing allowances if applicable)Add workerRemove worker(Complete This Section Only If your Organization Have Employees) AGREEMENT SECTIONI understand that no coverage can be bound or modified by voice mail, email, and fax or online via the agency’s website and is not effective until confirmed directly with a licensed agent. This is not an offer of insurance.Administrator Signature*Print NameCaptcha Δ This iframe contains the logic required to handle Ajax powered Gravity Forms.