Prospect Hill Company
Altar Bread Program Form

Please provide the following contact information:

Name
Church/School Name
Phone Number
FAX Number
E-mail

Please provide the following shipping information:

	SHIPPING
Street Address
Address (cont.)
City
State
Zip Code

Please provide the following ordering information:

QTY	DESCRIPTION

Choose one of the following options:

Click here to make this a Standing Order - Ships every 2 weeks
Click here to make this a Standing Order - Ships every month
Click here to make this a Standing Order - Ships every 6 weeks
Click here to make this a Standing Order - Ships every 3 months
Click here to make this a Standing Order - Ships every 4 months
Occasionally (Contact us as needed)

We will include the shipping costs in your invoice.

YOUR ORDER WILL NOT BE DELIVERED TO US UNLESS YOU CLICK THE SUBMIT FORM BUTTON!