EmailMe Form - Tithe Receipt Form for 2016

Name *

Prefix First Last Suffix

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Previous Address if Less than 3 years

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Best Contact Phone Number *

### - ### - ####

Email *

If you are married, would you like your spouse's information to be combined with yours for this year? *

Yes

No

If yes, Spouse's name

First Last

How would you like to receive your receipt? *

Pick Up

Mailed

Emailed

Are you a member of Patmos Chapel?

Yes

No

Have you used Online Giving anytime this year?

Yes

No