SHALOM COMMUNITY
CHRISTIAN CHURCH
CD/DVD
Order Form
NAME
______________________________________________________
ADDRESS
__________________________________________________
CITY________________ STATE____ ZIP CODE________
PHONE NUMBER
___________________________________________
EMAIL ADDRESS
___________________________________________
TITLE OF MESSAGE (S)
_____________________________________
PLEASE CHECK BELOW THE NUMBER
OF CDs or DVDs DESIRED:
CD (love offering of $5
each) _____
DVD (love offering of $10
each) ________
METHOD OF PAYMENT: _____________
________________
CHECK CREDIT
CARD
IF PAYING BY CHECK, PLEASE MAKE CHECK OUT TO
“SHALOM COMMUNITY CHRISTIAN CHURCH” and mail to
POBOX 21525
GREENSBORO, NORTH CAROLINA 27420
IF PAYING BY CREDIT CARD, PLEASE PROVIDE
THE FOLLOWING INFORMATION CREDIT CARD TYPE:
__________
________________
VISA MASTERCARD
CREDIT CARD NUMBER:
__________________________________
EXPIRATION DATE:
_______________________________________
PRAYER REQUEST(S): _____________________________________
___________________________________________________________
___________________________________________________________
HOW DID YOU HEAR ABOUT SHALOM?
WEBSITE
_________
TV ________ FRIEND ___________