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Care Fund Request Form
Hope for the hardest of times.
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* Indicates required question
Email
*
Your email
What is your name?
*
Your answer
What is your phone number?
*
Your answer
How did you hear about us?
Your answer
What are you requesting money for?
*
Rent/ Mortgage
Electric bill
Medical assistance
Vehicle Repair
Other:
How much money are you requesting?
*
Your answer
Who would the check be made payable to (which company or service provider)?
*
Your answer
What is their phone number?
*
Your answer
What is their address?
*
Your answer
When is your bill due?
*
Your answer
In the last 12 months has one of our church care funds assisted you in paying a bill? (If Yes, please list the date of last assistance and what it was for.)
*
Your answer
Do you visit the Point Church care pantry or another care pantry?
*
yes
no
Other:
Which church do you attend?
*
Point Church
Kings Cross
Oak Community
Other _____________________________
None
Required
Are you a member of that church?
Yes
No
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