Name _________________________ Church Name ____________________________
Address _____________________________________________________________________
City _________________________ State ________ Zip Code ______________________
Home ________________________ Work ___________________________
Cell __________________________ Email ______________________________
Please list any other information you feel will aid us in placing your order.
____________________________________________________________________________
____________________________________________________________________________
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If you would like to place your order with a credit card, you may include the necessary information below.
Name on card ______________________________________________________________
Complete billing address including _______________________________________________
City _________________________ State ________ Zip Code ______________________
Circle Type of card: Mastercard / VISA / Discover / American Express
Credit card # ____________________________ Exp date _______ SVC code ______ (off back of card)
Amount to be charged $_______________
By signing below, you authorize National Robe Corporation to charge the stated amount above on the given credit card information above.
Signature ____________________________________________ Date ________________
National Robe Corporation
3531 Rehobeth Church Road Greensboro, NC. 27406
local 336.547.0492 toll free 800.707.9559 fax 336.852.3271
Website: www.nationalrobe.com Email:
CLOAKING