Life Impact Ministries - Order Quizzing CD's

Use this form to purchase DVD's. When all data is entered, select the "Submit" button to send.

After completing the form below and submitting, send a check for the total amount to the address below. Make checks payable to
Life Impact Ministries. Allow approximately two weeks for delivery from the time a check is received.

Life Impact Ministries
P.O. Box 20039
York, PA 17402 For Coach & Promotional DVD costs click here.

* Required

Specify Quantity of Coaches DVD's:

Specify Quantity of Promotional DVD's:

Specify Quantity of 2009 Picture DVD's:

Specify Quantity of 2009 Slide Show DVD's:

* First Name:

* Last Name:

* Mailing Address:

* City:

* State:

* Zip:

* Telephone Number:

* E-mail Address:

* Church Name:

Please type additional comments below.