Host Site Application

* Indicates a required field

Church/Organization Information
* Organization
    Name
* Street Address
 
* City
* State
* ZIP
You MUST enter a valid email address to be accepted
* E-Mail Address
* Reenter Email
You will be sent an email to verify your address
 
 Mailing
Address
 
 City
 State
 ZIP
 Website
* Phone #1 Ext Type
Phone #2 Ext Type
Fax        
Pastor Information
Salutation
* First Name
Middle Name
* Last Name
Suffix
 
Email Address
* Address
 
* City
* State
* ZIP
* Phone #1 Ext Type
Phone #2 Ext Type
Host Site Information
Host Site Director Name
Salutation
* First Name
Middle Name 
* Last Name
Suffix
 
Email Address
Host Site Address
* Address
 
* City
* State
* ZIP Code
* Phone #1 Ext Type
Phone #2 Ext Type
Distribution Information
What is your church/organization size?
What year was your church/organization founded?
Church/organization denomination/affiliation
Type of facility you will utilize for distribution?
(i.e. fellowship hall, church basement, foyer, etc.)
* Do you have refrigeration available?
Refrigeration type?
* Are you going to pick up your orders in Monroe, Georgia, or will you require delivery?
If delivery is required, please attach directions to your facility
Requested Start Date (MM/DD/YYYY)
* Referred By
Check here to receive email notifications from us
Notes
Substitute Form W-9
* Name (as shown on your income tax return)
* Business name
* Individual/Sole proprietor Corporation Partnership Other (please specify)
Exempt from backup withholding
* Address (number, street, and apt. or suite no.)
* City, State, and ZIP code
List account number(s) here (optional)
* Fed. Taxpayer # (FEIN)
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
Check if exempt from item 2
3. I am a U.S. person (including a U.S. resident alien).
Certification instructions. You must check above that you are exempt from item 2 if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See the instructions on page 4 of form W-9.)
This form is provided for your convenience as part of your application.
If you wish to view the full IRS form W-9 or its instructions then click the appropriate button below.
IMPORTANT: Any applicable sales taxes must be collected, reported and paid by the host site to their state's department of revenue. Not all states impose sales taxes on food. Please contact your state revenue office for information concerning sales tax in your state.
The following information is requested by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of the applicants on the basis of visual observation or surname.
Gender Male
Female

Family
Hispanic or Latino? Yes
No
Race: (Mark one or more)
White Black or African American   Asian
American Indian/Alaska Native Native Hawaiian or Other Pacific Islander
I understand that my application is subject to approval by Angel Food Ministries and that the application process may take up to 10-12 weeks. I also understand that I cannot submit an order until I have received approval and training from Angel Food Ministries. Any questions regarding my application can be directed to Angel Food Ministries.

  

Your application should be accompanied by a $50.00 check payable to Angel Food Ministries and your W-9 (you will get a printable W-9 after pressing Submit). This will help us defray the cost of your training materials. In the event you are not approved, your money will be refunded.
Upon completion, please mail your application to:
P.O. Box 128 Good Hope, GA 30641
Phone 770-267-7015   Fax 770-267-8031
 
Angel Food Ministries is an equal opportunity provider and employer.
Complaints of discrimination should be sent to
USDA, Director, Office of Civil Rights, Washington, DC 20250-9410

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