Order Form - Prayer Coin ™


Organization/Company Name: ___________________________________________

Name: _____________________________________________________________

Street Address: ______________________________________________________

City/State/Zip/Country: ________________________________________________

Phone #: ___________________________________________________________

Email Address: ______________________________________________________

Order Today! Quantity Subtotal
Prayer Coin™ ______ X $5.00/10 pack $_______

Shipping/Handling (USA),
(USA).80 cents/10pack $_______
(Canada) .90 cents/10pack $_______

Michigan Residents add
6%, .30 cents Sales Tax $_______

Total $_______

Please make checks or Money Orders Payable to:
Fisher Family Enterprises
1812 Stoney Point Drive
Lansing, MI 48917

Contact via email: [email protected]
Website: www.prayercoin.com
Phone (517) 882-5240