Register | Clergytech

Client Registration Form
Ministry Name and Address
Ministry Legal Name*
Ministry Doing Business as (DBA) or common name*
Physical Address*
City, State and Zip Code*
County or Parish*
Ministry Contact Information
Mailing Address (if different from above)
Courier Address (if different from above - must be a street address)
Telephone Number*

Ministry Payroll Tax Information
Federal Taxes
Is your ministry exempt from Social Security and Medicare tax withholdings and matching on payments made to non-ministerial employees?*
- Yes
- No
Important: The question above relates to the ministry opting out of withholding and matching social security and medicare taxes on payments made to non-ministerial employees by filing IRS Form 8274. This question is not related to ministers who have individually opted out of social security and medicare coverage by filing IRS Form 4361.
Has the IRS notified your ministry that you are to file IRS Form 944 (Employer’s Annual Federal Tax Return) instead of IRS Form 941 (Employer’s Quarterly Federal Tax Form)?*
- Yes
- No
Federal Employer Identification Number (FEIN)*
How frequently is your ministry required to make federal payroll tax deposits?*
State Payroll Taxes
Is your ministry required to withhold and pay state income tax on employees?*
- Yes
- No
State Employer Withholding Tax Account Number*
How frequently is your ministry required to make state payroll tax deposits?*
Local Payroll Taxes
Is your ministry required to withhold and pay local income tax on employees?*
- Yes
- No
Locality or Jurisdiction*
Local Employer Withholding Tax Account Number*
How frequently is your ministry required to make local payroll tax deposits?*
State Unemployment Tax
Is your ministry required to to pay state unemployment tax (SUTA)?*
- Yes
- No
Most ministries are exempt from state unemployment tax. However, if your ministry has voluntarily opted to pay or is otherwise required to pay state unemployment tax, please provide the following information:
State Unemployment Tax Account Number*
State Unemployment Tax Rate*

Ministry Payroll Information
Primary Payroll Submission Method*
- Web Entry
- Automatic*
- Email
*Our automatic payroll option eliminates the need to initiate your payroll over the internet each pay period. It is a great option for ministries with all salaried staff.
Number of Employees*
Payroll Frequency*
Please enter the beginning date, ending date and pay date of your next two pay periods:
Beginning Date*
End Date*
Pay Date*
Beginning Date*
End Date*
Pay Date*
Ministry Banking Information
This section is for information related to the checking account from which we will draft your payroll. It is extremely important that this information be correct. Inaccurate or incomplete information will delay your account setup. Your designated account must be a regular checking account that accepts ACH transactions. Savings accounts, Money Market accounts and other restricted accounts will not work with our system. If in doubt, your bank can tell you if your account can accept ACH transactions.
Bank Name*
Bank Routing Number*
Checking Account Number*
Submission of this information constitutes your ministry’s official authorization for us to establish this account in our system as your ministry’s authorized account for ACH transactions to process transactions in accordance with the terms of your services. To verify your account, we will withdraw $1 and issue a refund upon confirmation.

Ministry Payroll System Administrator
The payroll system administrator will have full access to your client portal and all functions related to your ministry.
Payroll Administrator (Mr./Mrs./Pastor, First Name, Last Name)*
Official Ministry Title (Senior Pastor, Treasurer, Admin, etc)*
Personal Day Time Phone Number*
Email Address*
Additional Contact
- Additional Contact
Name (Mr./Mrs./Pastor, First Name, Last Name)*
Title (Senior Pastor, Treasurer, Admin, etc)*
Personal Day Time Phone Number*
Email Address*
Certification of Preparer
I do hereby attest and certify that I have the authority, as set forth by the internal governing rules of the Ministry herein named, to initiate payroll services through the auspices of ChurchPayroll.com and to submit the information contained herein.
I understand that important aspects of our payroll services will be processed based on the information I have furnished on this form. I hereby certify that the information contained herein is accurate and complete to the best of my knowledge and do herewith authorize ChurchPayroll.com to act with reliance on the accuracy of the information contained herein.
Preparer’s Name (Mr./Mrs./Pastor, First Name, Last Name)*
Official Ministry Title (Senior Pastor, Treasurer, Admin, etc)*
Personal Day Time Phone Number*
Email Address*
Terms and Objectives
Consent*
I have read and I accept the terms of the above Letter of Engagement for Payroll Service
Signature
Sign your name in the box below
Signature*
Comments
This field is for validation purposes and should be left unchanged.

Client Registration Form

Ministry Name and Address

Ministry Contact Information

Ministry Payroll Tax Information

Federal Taxes

State Payroll Taxes

Local Payroll Taxes

State Unemployment Tax

Ministry Payroll Information

Ministry Banking Information

Ministry Payroll System Administrator

Certification of Preparer

Terms and Objectives

Signature

Letter of Engagement for Payroll Service