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Form to request The Beginner's Bible for someone other than yourself.

Information about yourself
Your First and Last Name  
Your Email Address  
Your Phone Number  
Relationship to the blind individual     (Mother, Grandmother, Friend, Pastor, etc)
Information about the blind individual you are requesting The Beginner's Bible for
First and Last Names  

Street Address

  
Extra Address Line  
City  
State  
Postal or Zip Code  
Country  
E-mail  
Phone  
Date of Birth    

If the blind individual is a minor we must have the name of his or her parents or legal guardian!
Parents or Guardian's Name  
Please describe how 
this book will be used 
and additional comments.		  
Shipping Information We ship our Bibles via "Free Matter for the Blind" through the United States Postal Service.  Please allow 6 to 8 weeks for shipping.
            Ship Directly to the blind individual at the address above. 
            Ship to the following shipping address:
Ship to Name  

Street Address

  
Extra Address Line  
City  
State  
Zip or Postal Code  
Country