SHALOM COMMUNITY CHRISTIAN CHURCH

CONTRIBUTIONS FORM

 

MAIL TO:

Shalom Community Christian Church
2227 Pinecroft Road, Greensboro, North Carolina 27407
(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) ______________________________________________

 

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HOW DID YOU HEAR ABOUT SHALOM?

WEBSITE   _________      TV   ________    FRIEND ___________

NEWSPAPER _______      RADIO ______   OTHER   ___________