Third Order of Penance of St. Dominic

Sacramental Request

Please fill out the following form, so that we may send you Our Lady's gifts...

Please provide the following contact information and a delivery address:

First Name *

Last Name *

Middle Initial

Organization

Street Address *

Address (cont.)

City *

State/Province *

Zip/Postal Code *

Country *

Home Phone *

E-mail *

* These fields are required to have sacramental request processed

(Sorry- International orders are no longer processed: USA and Canada only)

Please provide the following ordering information:

QTY DESCRIPTION

Brown Scapular (mandatory minimum donation $ 0.25 per sacramental)

Green Scapular

Rosary Beads

Miraculous Medal

Request require donation prior to delivery. All internet request will be put on hold until donation is received.

Please make donation in US Dollars

Please cover cost of shipping and handling by following USPS shipping rates.

How did you hear about the Third Order of Penance of St. Dominic?

To Print:

Step 1-Fill out form

Step 2-Press Control All (Ctrl + A)

Step 3- and then Print

Step 4- send in Request at provided address with check or money order.

Please enclose check or money order made payable to: Willing Shepherds of Jesus Christ Chapter

Send to:

Third Order of Penance of St. Dominic

Willing Shepherds of Jesus Christ Chapter

321 South Broadway

Lawrence, MA 01843

USA

You will receive your sacramentals within 2 weeks

First Name	*
Last Name	*
Middle Initial
Organization
Street Address	*
Address (cont.)
City	*
State/Province	*
Zip/Postal Code	*
Country	*
Home Phone	*
E-mail	*

QTY	DESCRIPTION
	Brown Scapular (mandatory minimum donation $ 0.25 per sacramental)
	Green Scapular
	Rosary Beads
	Miraculous Medal

Third Order of Penance of St. Dominic

Sacramental Request

Copyright © 2008 [Third Order of Penance of St. Dominic-Willing Shepherds of Jesus Christ Chapter.]. All rights reserved. Revised: 02/12/09

Copyright © 2008 [Third Order of Penance of St. Dominic-Willing Shepherds of Jesus Christ Chapter.]. All rights reserved.
Revised: 02/12/09