5 Good Reasons - DVD/CD Request Form

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Welcome To the DVD/CD Request Form.

Requests are for products that will be available after a suggested donation of amounts:

Video DVD sets are $20 each.

Audio mp3 CD sets are $10 each.

Combo: Video DVD set & Audio mp3 CD set - $25

Shipping cost per order is $5.

All Information Will Be Protected And Will Not Be Sold Or Distributed.

Name*

First

Last

Address*

Address 1

Address 2

City

State

Postal Code

Country

Phone Number*

Number Of DVD Sets You Are Requesting?

Number Of CD Sets You Are Requesting?

Are You Requesting Shipping (yes or no)?

Donation Total Instructions

Total Donation*

Seventh-day Adventist® Church