Assistance Form


Get Out The Hole & Get Into Islam

"A   kind word and forgiveness is better than a charitable deed followed by hurt; and God is self-sufficient,   forbearing".  

Information for person applying (please print clear or type)

  

  • Legal   Name/ Islamic _______________________

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  • Home   address ___________________________
  •  
  • City,   State, Zip ____________________________

  •  
  • Home   #/ Cell # ____________________________

  •  
  • Email ___________________________________

  •  
  • Occupation/how   long _______________________

  •  
  • Occupation   of Spouse _______________________

  •  
  • Dependence   & age _________________________

  • Household Expenses _________________________
  •   
  • Rent/   Electric/ Water/ Gas ____________________

  •  
  • Food/   Phone/ Internet _______________________

  •  
  • Car   Note/ Car Insurance _____________________

  • Please provide the assistance you need ____________________________________________________________________________________________________________________________________________________________________
  •  
  •  
  • Applicate   Signature _________________________________


  • Date ___________________


 

Getoutthehole@gmail.com

Get_into_islam@yahoo.com

281-870-2827



Get Out The Hole & Get Into Islam

P.O.BOX 550561

Houston, TX. 77255



Please download and print all information on form and sign. 


Please send in a copy of your id and bill.


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