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Birthday Supply Order Request

* Indicates a Required Field

Name Information:

* First Name: This is a required field. Minimum number of characters not met. Exceeded maximum number of characters. Invalid postal code format.

* Last Name: This is a required field. Minimum number of characters not met. Exceeded maximum number of characters. Invalid postal code format.

* Telephone Number:
Example: 314-555-1234 A telephone number is required. Invalid telephone format.

Shipping Information:

* Church Name: This is a required field. Minimum number of characters not met. Exceeded maximum number of characters. Invalid postal code format.

* Address: This is a required field. Minimum number of characters not met. Exceeded maximum number of characters. Invalid postal code format.

* City: This is a required field. Minimum number of characters not met. Exceeded maximum number of characters. Invalid postal code format.

* State: Please select an item.

* Postal Code: This is a required field. Minimum number of characters not met. Exceeded maximum number of characters. Invalid postal code format.

* Email Address: Minimum number of characters not met. Exceeded maximum number of characters. Invalid email format.

Supply Request:

* Birthday Banks

* Birthday Cards: Balloons

* Birthday Cards: Cupcakes

* Birthday Cards: Fuzzy Characters

* Birthday Cards: Ribbons

* Birthday Mugs

* Offering Envelopes

* Pencils (Box of 144 pencils)