Harrisburg Christian Church - Financial Help Application

Financial Application

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Email

Have you had a recent loss of income or unexpected expenses? Explain:

What other financial assistance have you sought or applied for? Explain:

Are you a member of a local church?

What are some specific needs or bills that we can help with? Please be specific.