Please review our Individual Grant GuidelinesĀ here before completing the form below. If you have any questions about our Mutual Aid Ministries Individual Grant Request form, please contact us at info@maxinsurance.com.

Person Completing This Request

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* 1. Person Completing This Request

Are you currently insured by MAX directly, or through one of our independent agents?

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* 2. Are you currently insured by MAX directly, or through one of our independent agents?

Relationship to Grant Recipient (member of my church, relative, neighbor, friend, etc.)

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* 3. Relationship to Grant Recipient (member of my church, relative, neighbor, friend, etc.)

Does the Grant Recipient know you are submitting this request on their behalf?

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* 4. Does the Grant Recipient know you are submitting this request on their behalf?

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