Section 1
Organization
* Name
* Address1
Address2
* City
* State
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
* Zip
*
Telephone
Fax
* Email
*
Categories
Web Site Address
Section 2
Program Coordinator
Primary
* Name
Title
*
Phone
*
Email (We require 2 different email addresses.)
Secondary
Name
Title
Phone
Email
Section 3
* Federal Tax ID Number
Section 4
NPO User Name,
Password, and ID
* Select NPO User Name
What is the primary coordinator’s mother’s maiden name?
*
EPC NPO (Nonprofit) Passport Number (For internal use only)
Section 5
Organization's
Bank
*
Name
*
State
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
* Checking Account Numer(See sample below.)
* Bank Routing Number (9 digits -- See sample below.)
