Greenridge Financial Information Form
In order for Greenridge Baptist Church to help as many people as possible, with the resources God supplies, please provide a copy of the bill/invoice you are requesting assistance with, as well as the following information:

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Email *
How did you hear about us? *
Your Name: *
Address: *
Phone Number: *
Spouse/Partner's Name *
Spouse/Partner's Phone Number *
How many children do you have in the residence? *
What are the ages of those children? *
Housing Information - Do you:  *
Please describe the financial need you have and the amount you are requesting: *
Please describe any circumstances, crises, relationship issues that have contributed to your current financial need (for example: lost job, spouse left, medical issue): *
Current Monthly Income
Wages/Salary/Pension from your employer: *
Child Support Income: *
Supplemental Security Income (SSI)/Disability *
Unemployment Benefits (State or County): *
Other sources/savings: *
Are you currently employed? *
If Yes, where? (Employer Name, Address, Phone #)
If No, where/when did you last work and why did you leave?
 *
Regular Monthly Expenses
Rent or mortgage payment: *
HOC Supplement *
If Yes, how much?
If No, NA
 *
Monthly Expenses (Utilities, Car Payment, Insurances, Food, Technology, Clothing) *
Credit card/student loan payments: *
Total  Monthly Expenses: *
Have you gotten help from other organizations? *
If Yes, from who and how much?
If No, NA
 *
By checking this box, I certify that the information on this form is true and correct and you authorize us to check with Rental Agency and Utilities in order to validate assistance. *
Required
After you have provided this information, please email a copy of the bill (or lease agreement) that you are requesting to help@greenridgebaptist.org
Please note it may take 5-7 days before you receive a response.  Greenridge Baptist Church and its leaders reserve the right to decline assistance to any person based on its available resources, volume of requests or unforeseen circumstances. Requests are reviewed every Wednesday and notifications are made on Thursday.
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