JudahBible Curriculum Order Blank
Tel 217-344-5672
P.O. Box 122 Urbana, IL 61802 FAX 217-344-0446
Order Date/Time : ______________________________
========= ORDER INFORMATION =========
Description :
_______ JBC Pack @ $69.00 ________________
_______ JBC Online @ $37.00 ______________
_______ JBC Manual @ $42.00________________
_______ JBC Audio Seminar @35.00___________
______ Other______________________________
Total _______________
============== RESULTS [FOR OFFICE USE ONLY] ==============
Invoice #: ________________
Response : This transaction has been approved?
Authorization Code :
Transaction ID :
Date Shipped:_______________ Service Used:________________
==== CUSTOMER BILLING INFORMATION ===
First Name :
Last Name :
Company/School :
Address :
City/State/Zip:
Country :
Phone :
Fax :
E-Mail :
=== CUSTOMER SHIPPING INFORMATION IF DIFFERENT THAN ABOVE===
Address:
First/Last Name:
Company/School :
Address :
City/State/Zip:
Country :
=== PAYMENT INFORMATION ===
Payment Method [example: credit card]:
Date processed:
Check enclosed:
Order total:
Card type:
Name on card:
Card number:
Expiration date:
Signature Code on back of card: