NDC Online PAW Church Assessment Form

Date Submitting Form

MonthDayYear

Church Name

Church Address

Church Street Address

Church Street Address Line 2

Church City Church State / Province

Church Postal / Zip CodeCountry

Church #

Area CodePhone Number

Church FAX #

Area CodePhone Number

Pastor's Name

Pastor's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Church Size 1-49 ($50 + 3% Online Processing Fee) $52.00

# of months

Church Size 50-99 ($125 + $5 Online Processing Fee) $130.00

# of Months

Church Size 100-249 ($210 + $9 Online Processing Fee) $219.00

# of Months

Church Size 250-499 ( $420 + $17 Online Processing Fee) $437.00

# of months

Church Size 500-999 ($835 + $34 Online Processing Fee)$869.00

# of Months

Church Size 1000-1499 ($1250 + $50 Online Processing Fee)$1,300.00

# of Months

Total $0.00