KMVT Church/Business Closing Code Request



1.Name of Church, Business or Organization:
2.Location of Church, Business or Organization:*
3.Primary Contact Name
4.Primary Contact Phone number (Please include area code):
5.Primary Contact Email Address
6.Secondary Contact name
7.Secondary Contact Phone Number
8.Secondary Contact Email Address
9.List of people authorized to close your Church, Business or Organization:*
10.Please enter your date of birth.
Month* Day* Year*

11.Terms and Conditions
I have read, understand, and agree to the Website usage agreement and privacy policy.
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You must be 18 years of age to submit.