REQUEST FORM
DATE:___________________________________
CHURCH NAME & ADDRESS_________________________________________
_____________________________________________________
PHONE_______________ EMAIL_______________________
LMSG CHURCH LIAISON: ______________________________________
IS THIS A ROUTINE OR EMERGENCY REQUEST?
ROUTINE:______________ _______________________________
EMERGENCY EVENT:___________________________________________________
_________________________________________________________________
NAME OF PERSON OR PERSONS INVOLVED:_____________________
WHAT IS THE REQUEST FROM LMSG: ___________________________
HOW WILL THIS REQUEST OVERCOME THE EVENT? _____________
DESIRED OR REQUIRED AMOUNT $___________
REQUEST SUBMITTED BY: (or designee with contact information) (at least 2 of 3 signatures)
CHURCH PASTOR SIGNATURE: _____________________PHONE____________
CHURCH PRESIDENT SIGNATURE __________________PHONE____________
CHURCH LIAISON SIGNATURE: ____________________PHONE_____________
**(Please print request form, sign and mail to: LMSG C/O Dwight Johnson, 6640 Northwind Dr. Colorado Springs, CO 80918 OR scan and email to Dwight Johnson)
