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Mail Order Form
Print and use this form when
ordering by mail from:
Gospel GEMs
P.O.
Box 440
Midlothian, Texas, 76065-7201
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 |
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Free Shipping to
US
International Rates: Based on total cost of order (US Funds):
$0 to $10 = $15
$10 to $20 = $22
$20 to $30 = $29
$30 to $40 = $36
$40 to $50 = $53
$50 to $60 = $60
$60 to $70 = $67
$70 to $80 = $74
$80 to $90 = $81
$90 to $100 = $88
Note: Iternational Mp3 downloads are Free! |
|
Shipping |
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Send Credit Card Info, Check or
Money Order
(US Funds) |
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TOTAL |
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