Subscription Order

You’ve made a great decision to measure the impact of your church ministries!

Please complete the form below to place your 3 year subscription order.

Your Name:*
Email address*
Church name*
Church Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary contact name (if different from above)
Primary Contact Phone*
Primary Contact Phone Extension (if applicable)
Primary Contact Email

Vital Impact Assessment 3 Year Subscription Purchase*
Find your church attendance size in the list. Cost is based on average weekly attendance. Cost is billed 1x per year and includes 1 survey for your church per year for 3 years.
Sub Total:
$0.00
Select Survey Language
Add 1st Year Video Conference Consultation Meeting (Optional)*
This is a one time 60 minute meeting with a consultant from our team to go over the results with your leadership team.
Add Additional Questions (Optional)*
Would you like to add some additional questions to the survey? Additional questions are $50 per question and you may add up to 4.
Question 1 text
Please write out your open-ended question that you want to add below.
Question 2 text
Please write out your open-ended question that you want to add below.
Question 3 text
Please write out your open-ended question that you want to add below.
Question 4 text
Please write out your open-ended question that you want to add below.
Add Community Mapping (Optional) 1st Year*
Understand your community better with the creation of customized maps of geographic areas within your community, get detailed community profiles, and also household demographics (age/gender/race/income) for that area. View full details on each plan option here: Mapping Plans
Coupon (if any)
TOTAL COST:
$0.00
Credit Card*

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Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Phone
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