Mail Order Form

Print and use this form when
ordering by mail from:

Gospel GEMs
P.O. Box 4337
Winchester, VA 22604, USA

   Mailing Info (If paying by Check or Money Order, or if different than Billing Info below):

  • Name: _________________________________________________________________
     
  • Address: _______________________________________________________________

  • City: ________________________ State/Province: ____________________________
     
  • Zip/Postal Code: ________________  Country: _______________________________
     
  • Phone:_____________________    E-Mail: ___________________________________
     

Billing Info (If using one of these Credit Cards):   Visa, MasterCard, Discover, and American Express.

  • Name:__________________________________________________________________
     
  • Credit Card Number: _______________________________  Exp. Date: ____________
     
  • Exact Name on Card: _____________________________________________________
     
  • Address Credit Card is Billed to: __________________________________________________
     
  • City: ________________________ State/Province: ____________________________
     
  • Zip/Postal Code: _______________  Country: ________________________________
     
  • Phone:_____________________    E-Mail: ___________________________________

    CDs are $1.00 ea, MP3's $ .50 ea, Bundles priced as listed in brochure.

    QTY

     Product
     ID

    Title or Name of Product

    Format
    CD/MP3?

    Price Ea.

    -- Total --

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       Sub-Total .

    Free Shipping to US/Canada/Mexico (Other countries Add $5.00 USD here for total order of CDs, MP3s, BBB-CD)

      Shipping .

    Send Credit Card Info, Check or Money Order (US Funds)

      TOTAL  .