Resource Center Video Order Form

Personal information:

Name (First/Last)
Church or organization
Zip code
Day-time phone
E-mail address

UPS shipping address (if other than church):

Street address
City
State
Zip code

Requested video:

Title
Catalog # (if known)
Ship for date	(mm/dd/yy)
ASAP
Return date	(mm/dd/yy)

You may print out and fax this form to: (847) 931-0732
or submit the information via e-mail:rblake@umcnic.org.

THANK YOU FOR YOUR ORDER!

You will be contacted within 24 hours regarding the status of your order.
If you have any questions or you are not contacted within 24 hours, please call:
(847) 931-0710, ext. 17
e-mail: rblake@umcnic.org.