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.

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       Sub-Total .

    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 .

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

    		   TOTAL  .