| First Name: |
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| Last Name: |
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| Email: |
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| Church or Organization: |
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| Church or Organization Address: |
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| Church or Organization City: |
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| Church or Organization State: |
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| Church or Organization ZIP: |
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| Church or Organization Telephone: |
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Please complete Option 1 -OR- Option 2 below |
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| OPTION 1 - SITE STUDY Demographics report by address |
| Address: |
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| City: |
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| State: |
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| ZIP: |
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You can choose up to 3 rings of distance from your specified address. Please enter the number of miles or drive-time minutes from your specified address. A suggested default is 1, 3 and 5 miles for miles, and 5 , 10 and 15 minutes for drive time. |
| Choose Miles or Drive Time Minutes: |
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| Miles/Minutes 1: |
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| Miles/Minutes 2: |
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| Miles/Minutes 3: |
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| Please note: You cannot mix and match distance in miles and distance in drive times. |
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| OPTION 2 - AREA STUDY Demographics report for a standard geographic area |
| You can choose up to 3 gepgraphic areas for your report. Areas can include states, counties, ZIP codes, cities or towns, or metropolitan areas. |
| Please enter your 3 defined areas: |
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| Please note: You can mix and match geographic areas (e.g., a state, county and a ZIP code are acceptable). Maps are not available for area studies at this time. |
| Additional Comments: |
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