p. (877) 529-2732 email: sales@lazarministries.com

Send this form with Payment to: Lazar Ministries 2413 W. 60^th St. Davenport, IA 52806 Or fax it to: (800) 667-1136

Web Order Form

Name (as it appears on your credit card)
Billing Address
City, State, Zip
Email
Phone
Fax (if applicable)
Qty. _______X $15.00 each = + Shipping ($2.00 Per CD) TOTAL	$ ________________ ________________

Please check your desired method of payment:
Visa   Mastercard   AmEx   Discover   M. O. or Check*
Credit Card Number:
Expiration Date:	__________/20____ (Month) (Year)	________ Card Verification Number **
* For personal checks, corporate checks, or money orders, funds must clear first before CDs will be shipped. ** Last 3 digits on the back of Visa, MC, or Discover; Last 4 Digits on the front of AmEx.