Individual/Trust Investment Application

1Applicant

2Options

3Joint

4Living

5UTMA

6Certificate

7Successor

8Spouse

Section 1: Applicant and Ownership Information
A field marked with a red asterisk is required.
Enter Primary Applicant's full name or Primary Trustee's full name, if applicant is a trust*
First Middle Last
Mailing address*
Address line 1 Address line 2 City State Zip code
E-mail*
A confirmation e-mail will be sent to the e-mail provided.
Enter e-mail Confirm e-mail
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Daytime phone*
Work phone
Date of birth*
MM slash DD slash YYYY
Both the Social Security and employer identification (EIN) numbers are nine digits. Include the dashes in your entry of either number (e.g., SSN 000-00-0000 or EIN 00-0000000).
?
Social Security or EIN*
Comments
Church Membership
Affiliation with the Wisconsin Evangelical Lutheran Synod. Before receiving the Offering Circular, you (or the Minor named with respect to our UTMA Program described in Section 1 hereof) are a member of the church identified in Section 1 or another congregation or other religious organization affiliated with the Wisconsin Evangelical Lutheran Synod. If you are an organization, corporate entity or institution, you are affiliated with the Wisconsin Evangelical Lutheran Synod.
Church name
City
State

Joint Ownership
You have selected the Joint Ownership option. We will issue the Certificate to the Primary Applicant and Joint Applicant as joint tenants with the right of survivorship. Under this arrangement, the consent of either owner alone will be sufficient to redeem the Certificate, transfer it or take any other action requiring the consent of the Certificate holder. Please include the following additional information.
Joint applicant #1 full name*
First Middle Last
Date of birth*
MM slash DD slash YYYY
The Social Security number is nine digits. Include the dashes in your entry.
?
Social Security number*
Do you have another joint owner?*
- Yes
- No
Joint applicant #2 full name*
First Middle Last
Date of birth*
MM slash DD slash YYYY
The Social Security number is nine digits. Include the dashes in your entry.
?
Social Security number*
Comments

Section 3: Payment on Death / Successor Custodian
Authorization
Primary beneficiary
By checking this box, you authorize WELS Church Extension Fund to pay the principal and accrued interest on your Certificate to the indicated 501(c)(3) tax-exempt organization or individual beneficiary at your death. Organizations may not select this option.

If you desire to designate more than one beneficiary, or to designate contingent beneficiaries in the event that the primary beneficiary predeceases you or no longer functions as a 501(c)(3) organization with a purpose consistent with your intended donation, please complete the separate online Beneficiary Designation Form.

You may also name a successor custodian to replace the custodian upon death of the named custodian.
Name of tax-exempt organization or individual beneficiary or custodian
Address
Address line 1 Address line 2 City State Zip code
Relationship
Date of birth
MM slash DD slash YYYY
Both the Social Security and employer identification (EIN) numbers are nine digits. Include the dashes in your entry of either number (e.g., SSN 000-00-0000 or EIN 00-0000000).
?
Social Security or EIN

Section 4: Representations and Agreement
Beneficiaries. If you have completed Section 3, you authorize WELS Church Extension Fund to pay the outstanding principal and accrued interest on your Certificate to the indicated beneficiary at your death. With regard to a donation, you acknowledge that it is advisory only and that WELS Church Extension Fund may refuse to honor your request. If at your death the tax-exempt organization you identified in Section 3 no longer functions as a qualified 501(c)(3) organization with a mission purpose consistent with your intended donation, you authorize WELS Church Extension Fund to designate another tax-exempt organization to receive your donation. You may change or revoke any beneficiary designation in Section 3 at any time. But a beneficiary designation and this Investment Application shall be binding on your heirs, beneficiaries and legal representatives. In addition, you represent either (i) that you are unmarried, or (ii) that your spouse has signed either this Investment Application as an Applicant, or the following Spousal Consent:
Spousal Consent
I am the spouse of the Primary Applicant or Joint Applicant identified in Section 1 of this Investment Application. I give to my spouse any interest I have in the funds to be invested in the Certificate applied for in this Investment Application. I agree to my spouse naming a beneficiary other than myself. I acknowledge that I have received a fair and reasonable disclosure of my spouse's property and financial obligations. I shall have no claim against WELS Church Extension Fund or any beneficiary designated under this Investment Application for any payment made to the beneficiary.
Date
MM slash DD slash YYYY
Signature of spouse of Primary Applicant
Type name of spouse of Primary Applicant
First Middle Last
Signature of spouse of Joint Applicant
Type name of spouse of Joint Applicant
First Middle Last
Privacy & Permission
Data Privacy & Permission*
I AGREE with the terms of the WELS Church Extension Fund Privacy Policy.
Data Privacy & Permission*
I agree to the terms of the WELS Privacy Policy.
NOTE TO EU CITIZENS, RESIDENTS, TOURISTS, AND OTHER PERSONS TEMPORARILY IN THE EU:

By submitting this form you consent to any and all information you provide and submit via the site being sent to the United States of America. The United States has not sought nor received a finding of “adequacy” from the European Union under Article 45 of the GDPR. WELS relies on derogations for specific situations as set forth in Article 49 of the GDPR. You are also informed that the United States presently does not have an adequate level of personal data protection as determined by the European Commission’s adequacy decision on October 6, 2015 (case c-362/14) and articulated in the European Union’s General Data Protection Regulation and has not received a similar designation of adequacy by any other foreign data protection authority. You agree to the transfer of your data and personal data to the United States, however, to be used in accordance with WELS Privacy Policy.

WELS Church Extension Fund: [email protected] or 866-511-7793 | Privacy policy
Ref: Individual/Trust Investment Application

Individual/Trust Investment Application

Section 1: Applicant and Ownership Information

Joint Ownership

Living Trust

UTMA Program

Section 2: Type of Certificate / Interest Options

Section 3: Payment on Death / Successor Custodian

Section 4: Representations and Agreement