Name:                          ___­_____________________________________________

Shipping Address: (no PO’s)    __________________________________________

City/State/Zip               ________________________________________________

E-Mail, Phone #        __________________________________

SHIPPING DATE                      ____________________________________________________________________________

_________________________________________________________________________________

May I substitute?       Yes        No  Please list bonus selections and substitutions on the back of the form. 

Make check/money order payable to:  THE VILLAGE CHURCH Flower Mound, TX or First Baptist Church Zachary, Zachary LA. I will forward the check to the church. There is one exception Madison check is to be made out to St. Jude.