4417 Dix Street, NE  ~  Washington, DC 20019

(202) 399-7774/5  ~  (202) 399-7770 (fax)

CD and Tape Request Form

Please complete and submit to a member of the Tape Ministry with your payment.  Make all

checks and money orders payable to Grace Apostolic Church and place into a church envelope.

Fill in the dollar amount submitted and under the Other category wirte Tape Ministry.

Requested By:

Name:

Date Requested:

Address:

Telephone Number:

City:

State:

Zip:

Sermon Title

Date

Quantity

Amount Total

¨

Cassette Tapes - $4.00

Amount Paid:  $ ____________________________

¨

CD's - $5.00

Date Received:  ____________________________

Method of Payment

¨

Cash

Order Filled By:  ___________________________

¨

Money Order

¨

Check

Amount Submittted

to Finance Office:  $ ________________________