Printable Form For Mail and Fax

Bible.com Ministries
P.O. Box 850 * Dewey, AZ * 86327 * USA
  Fax: (1-928-632-8122)

(TO ENSURE ORDER ACCURACY PLEASE PRINT/TYPE LEGIBLY!)

Bill To Information:			Ship To Information:

Company/Church:________________________ Company/Church:________________________

Name:__________________________________ Name:__________________________________

Address:_______________________________ Address:_______________________________

_______________________________________	_______________________________________

City:_________________________ City:_________________________

State:_________________________________ State:_________________________________

Zip Code:_______________________ Zip Code:_______________________

Day Time Telephone #:(_________) _________ - __________________ Ext:___________

Method of Payment
___Visa   ___MasterCard   ___American Express   ___JCB    ___Diner's Club

Credit Card Number:  _____________  _____________  _____________  _____________

Credit Card Expiration Date:  ________ / ________  

CVV2 Code (Visa/MasterCard = last 3 digits in signature area.):  ______________

CID Code (American Express = 4 digits above end of account #.):  ______________

Signature (For payment with a credit card.):  _________________________________

___Check or money order (If MAILING order with printed order form.)
   Payable to: Bible.com Ministries

Quantity: ISBN#(10 digits): Description                   Cost Each: Total:

________  ________________  _____________________________  _________  _________

________  ________________  _____________________________  _________  _________

________  ________________  _____________________________  _________  _________

________  ________________  _____________________________  _________  _________

________  ________________  _____________________________  _________  _________

________  ________________  _____________________________  _________  _________

________  ________________  _____________________________  _________  _________

________  ________________  _____________________________  _________  _________

________  ________________  _____________________________  _________  _________

                                                 Subtotal  ____________________

                           Shipping/Handling (see chart):  ____________________

                                        Shipping/Handling policies and options.

(Please do not include shipping for Bibles by the Case & FREE SHIPPING orders!)

                                                   TOTAL:  ____________________