                   ALCOHOLICS FOR CHRIST CATALOG ORDER FORM

Ship to: _____________________________________________________________________

Address: _____________________________________________________________________

         _____________________________________________________________________

Phone:   _________________________      Email: _______________________________

Method of Payment (check one)
___ Cashier's Check or Money Order(enclosed)   ___ Personal Check(enclosed)
    Please make checks payable to: Alcoholics for Christ
___ VISA      ___ MasterCard      ___ Discover

______________________________________________________     ____________________
Credit card number                                         Month      Year
                                                           Card Expiration Date

______________________________________________________
Card holders Signature

  Item                        Description                Donation
 Number   Quantity       and Size (if applicable)          Each       Total

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Please contact the office for                    Merchandise total  __________
Shipping & Handling charges.  
                                               Shipping & handling  __________
For delivery outside the continental U.S.,
please call the A/C office for instructions               Subtotal  __________

                                Donation to help with A/C expenses  __________

Please mail, phone or fax your order:                        Total  __________
     Phone: 248.399.9955 or 800.441.7877
       Fax: 248.399.1099
   Mail to: Alcoholics for Christ, 1316 N. Campbell Road, Royal Oak, MI 48067
   Please allow 15 days for delivery.

                     Your donation is very much appreciated.  THANK YOU!
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