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Deceased Perpetual Enrollment Form

Give the Gift of Prayer

For Christians, prayer is a way of life. In fact, prayer is the greatest gift that can be offered someone, beseeching God's favor upon him or her and entrusting his or her needs to Divine Providence. Using the list below, please select which Prayer Gift you would like to send.

* required information
Perpetual Enrollment - Deceased

(The suggested donation is $50)
:* $


Your Contact Information

Please complete the requested information below.

First Name:*
Last Name:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Province:
Country:
Email:*
Phone:

Donation Information

Payment Method
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Credit Card Type:*
                  
Credit Card Expiration:*


Credit Card Billing Information
If the billing information is the same as the contact information check this box.
If not please fill out the information below:
:*
:
:*
State:
:
:*
Country:*
Enrollment Card Information
Please enroll (Enter name as it will appear on the card):*
Enrolled by:*
Please send to (include name and complete mailing address):*

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