And  Registration  Form


Name of Church__________________________________________________________


Present Address: Street: ____________________________________________________

   City:  ___________________________ State: _______ Zip: _________ 


Name of Senior Pastor_____________________________________________________


Principal Church Contact: ________________________   Phone ___________________


Length of Time in Existence (years): _______ Is Church Incorporated Yes ____ No____


Church Membership______ Active Members _______Number of Giving Units ________


Last three (3) years (average) Plate Income $_________   Expenses (annual) $_________


Church Capitalization:  Equity ______   Mortgage__________ Other ________________

Funds available as down payment: $____________________________________

            Budget amount for monthly payment$____________________


501C3 Cert #____________    Federal I D #___________________

Do you have Capitol Funding /Building Program in place: Yes ______   No __________

Do you have an active Building Program Committee: Yes _____ No   _______________  

Are you presently working with a Lender Institution   Yes ____   No ____ 

If yes, Name of Lending Institution: __________________________________________

City________________________   State ________ Zip Code ________________

Contact Person:  _________________   Telephone # _______________________

Are you presently working with a Real Estate Broker/Agent:   Yes  _____  No ________
If yes, Name of Broker/Agent: ______________________________________________


Have you chosen a New Church Location:  Yes __   No ___  Asking Price $___________

Date you wish to Relocated_________________________________________________


If lender requires, will you and/or members of your Board sign as guarantor, and /or assign your personal real estate as additional security_____________________________
____________________________________________________________ ___________

If you are paying  “all cash” please include a confirmation of funds on deposit letter with this form

Please complete information and return to:

Rick Arzet, Associate Broker,

Berkshire Hathaway HomeServices Georgia Properties

3775 Roswell Road, Suite # 200   Email:

Marietta, GA 30062         

Fax 770- 973- 8826