Welcome to Church Plant Media, we're excited to partner with you!
Please review these items carefully before getting started:

Gospel Agreement: www.churchplantmedia.com/gospel
Radius Protection: www.churchplantmedia.com/design-style-availability
Pricing ($1000 + $50/month): http://www.churchplantmedia.com/pricing
Service Agreement/Terms: http://www.churchplantmedia.com/service-agreement-terms

Note: This form needs to only be filled out by new partners who desire to purchase their 1st website with Church Plant Media. If you're an existing partner desiring to upgrade your site or purchase an additional site, please go to www.churchplantmedia.com/upgrade to get started.
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First, let's get some basic information...

 
Which type of partner are you? *


 
What is the name of your {{answer_10182303}}? *

 
What denomination, affiliation, or group are you associated with? *

 
What is the office phone number?

 
What is the primary domain name (URL)?

If you don't have one registered yet, please feel free to skip this question (or write in the one you plan to register).
 
Does your {{answer_10182303}} have a physical location? *

This is the address that we will protect so no other church or organization in your area can have the same website as you. Usually this is the physical address where your church meets or where your organization is located. To read more about our Radius Protection, please go to http://www.churchplantmedia.com/radius-protection.

 
Great! Please type in your protected address below:

 
In what Country are you located? *

 
What is the street address? *

 
What is the City? *

 
What is the State? *

 
What is the Zip? *

 
Who will be the primary contact?

 
First Name? *

 
Last Name? *

 
Your role? *

Pastor, Administrator, Owner, Elder, etc.
 
Your mobile phone number?

 
How did you hear about us?


 
What word or phrase did you search to find us?

 
What is the name of the church, ministry or company that referred you to us?

 
What is the name of the friend, coworker or family member who recommended you to us?

 
What website did you see our logo on?

 
What advertisement did you see?

 
Which Design would you like to use?

We will check your address with our Radius Protection system and let you know if the design is available in your area.

 
Would you like us to include any of these add ons? *


 
If you've previously discussed a coupon code with our team, please enter it below:

 
Your total cost is {{var_price}}. Would you like to pay for your website online now, or receive an email invoice so you can pay online (or send a check) later? *


 
Who would you like the initial invoice to go to? *


 
Billing Contact's Information:

 
First & Last Name? *

 
The total cost of the website + add ons (if you selected any) is {{var_price}} *

 
Please enter your Credit or Debit Card number: *

 
The CVC number: *

(3 or 4 digit security number on the back of your card)
 
The name on your card: *

 
Your card's expiry month: *


 
Your card's expiry year: *


 
If you have any questions or comments, please note them here:

Thank you {{answer_10182311}}! You will receive an email shortly at {{answer_10182321}} describing the next steps of the process. We look forward to partnering with you!

If you have any questions in the meantime, please feel free to give our Sales Team a call at (800) 409-6631 ext. 1.
Visit our website!