SHALOM
COMMUNITY CHRISTIAN CHURCH
CONTRIBUTIONS
FORM
MAIL TO:
Shalom Community Christian Church
P. O. Box 21525, Greensboro,
North Carolina 27420
(336) 272-4GOD Email: shalomword@aol.com
NAME
______________________________________________________
ADDRESS
__________________________________________________
CITY________________ STATE____ ZIP CODE________
PHONE NUMBER
___________________________________________
EMAIL ADDRESS ___________________________________________
METHOD
OF PAYMENT TYPE: _____CHECK _____ CREDIT CARD
IF
PAYING BY CHECK, PLEASE MAKE CHECK PAYABLE TO:
“SHALOM
COMMUNITY CHRISTIAN CHURCH”
IF
PAYING BY CREDIT CARD, PLEASE PROVIDE THE FOLLOWING INFORMATION:
CREDIT
CARD TYPE:
____VISA ____MASTERCARD ____DEBIT CARD
CREDIT CARD NUMBER:
__________________________________
EXPIRATION DATE:
_______________________________________
AUTHORIZATION
CODE____
PRAYER
REQUEST(S) ______________________________________________
______________________________________________
______________________________________________
______________________________________________
HOW
DID YOU HEAR ABOUT SHALOM?
WEBSITE _________ TV ________ FRIEND ___________
NEWSPAPER
_______
RADIO ______
OTHER ___________