Shepherd's Watch Background Check Registration

Please fill out all required fields below to set up your Shepherd's Watch account with CIA.
(* indicates a required field):

E-mail Address: *
Create Password: *	- min 8 characters, 1 or more upper case letters, 1 or more lower case letters, 1 or more numbers and 1 or more of these special characters:~ ! # $ ^ * _ < >
Verify Password: *
Name: *	First Name: Middle Initial: Last Name:
Title:
Church Phone # *:	- - Ext:
Fax Number:	- -
Church Name: *
Group Publishing Acct #: *
Type of Business:
Street Address: *
Street Address 2:
City: *
State: *	* INTL * AK AL AR AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY
Zip/Postal Code: *
Church Size: *	1 - 99 100 - 199 200 - 299 300 - 399 400 - 499 500 - 799 800 - 999 1000 - 1999 2000+
What is the "Tax Status" on this account in the state of TX? *	-- Select Value -- Taxable Tax Exempt Taxes to State Reseller Located outside of TX (exempt from TX Sales Tax)
How did you hear about us? *	Shepherd’s Watch (Group)
Comments:
Enter the security word in the picture in the field below, then submit this form.