This is an explanation of the purpose of the form ...
Please identify and describe yourself:
Name Date of birth Sex Male Female
What type of credential do you desire? QTY DESCRIPTION PRICE Reverendship - i.e. Rev. J Smith - $20US Doctor of Divinity - i.e. Rev. Dr J Smith $30US Bishopric* *Dependent on available area $40US Cardinal - i.e. Cardinal J Smith $45US Papacy - i.e. Pope John Smith $50US BILLING Credit card VISA MasterCard American Express Diner's Club Discover Cardholder name Card number Expiration date SHIPPING Street address Address (contd.) City State/Province Zip/Postal code Country
What type of credential do you desire?