THE GOSPEL STATION NETWORK - A non-profit organization 501(c)(3)
WHITE CROSS Request

Business/organization
Optional
Name *
Prefix
First *
Last *
Suffix
Mailing Address:
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Phone Number

###
-
###
-
####
Email
Optional

SHIPPING COSTS

The postage costs us $10.00 for each cross. Please help us with the shipping costs if you can.
I will help with the shipping cost: *
 I will send a check (address below) 
 I will send cash or money order (address below) 
 I will donate with my credit or debit card (type info below) 
 I cannot give at this time. 
I will donate this amount for the shipping:
Enter dollar amount
I will donate this amount so more materials can be bought to continue this project
CARD.NUMBER
(no spaces)
NAME
As it appears on the card
Exp Date

MM
/
DD
/
YYYY
Enter the last day of the month
Billing address
If different from the MAILING address above
Street Address
If different from the MAILING address above
Address Line 2
If different from the MAILING address above
City
If different from the MAILING address above
State / Province / Region
If different from the MAILING address above
Postal / Zip Code
If different from the MAILING address above
Country
If different from the MAILING address above

FEEDBACK:

I heard about the white cross offer: *
 On the radio 
 Word of mouth 
 Saw it on your Gospel Station website 
 Saw it on your Facebook/Twitter/Instagram 
 Saw it on StandForTheCross.com 
 Read it in your email/ e-newsletter 
 Read it in your mailed out newsletter 
Tell these friends about the white cross offer:
(Name, email and address if possible)
Send info on The Gospel Station network of ministries:
 Yes 
 No 
Questions or comments:
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THE GOSPEL STATION NETWORK
PO BOX 1343
ADA OK 74821
1.800.557.8815
email@thegospelstation.com