Name (As it appears on the card.)
Home Phone
E-Mail
Address 1
Address 2
City
State
Zip
Country
Afghanistan
Albania
American Samoa
Andorra
Angola
Anguilla
Antigua
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Chad
Chile
China
Colombia
Congo Brazzaville
Congo Democratic Republic of
Cook Islands
Costa Rica
Croatia
Cyprus
Cuba
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
North Korea
Norway
Oman
Pakistan
Palau
Palestine Autonomous
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saipan
San Marino
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
South Africa
South Korea
Spain
Sri Lanka
St. Kitts/Nevis
St. Lucia
St. Vincent
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tanzania
Thailand
Tibet
Togo
Trinidad/Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
U.S. Virgin Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
U.S.A.
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis & Futuna
Yemen
Zambia
Zimbabwe
Credit Card Type
Select One
Mastercard
Visa
Card Number
Expiration Date
1 2 3 4 5 6 7 8 9 10 11 12
/
2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033
(mm/yyyy)
Credit Card Security Code
?
Amount in dollars
$
The purpose of your gift
My Preacher(s)
General Fund
Visionary Trip Food Bag
--------------Ministries-------------
Touch A Life Child
Gifts of Love
Timothy Project
Honduras Bible College
Bags Of Hope
Daily Bread
Unsupported Preachers Fund
Smugglers
Pennies For Preachers
TEAM
Proclaimer
Orphanage
-------------Urgent Needs------------
Tolupan - PowerPack Pico
Middle East Emergencies
House Church Rentals
Home Office Needs
Smugglers - Middle East
Home Office Repairs
Middle East Bags of Hope
Gospel Stocking
-----------Representatives-----------
Jon Nelms
Dennis Ellis
Oleg and Lori Enskaya
Jimnmy Queen
Other (Type below)
Other