Request Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#6666FF" TEXT="#080000" bgproperties="fixed" background="04500760egblyg.jpg"> <div> <FONT SIZE="5" COLOR="#330066" FACE="Times New Roman" ><B>C.O.L.O.M.</B></FONT><FONT SIZE="2" COLOR="#CC3399" FACE="Times New Roman" > </FONT><FONT SIZE="2" COLOR="#3300FF" FACE="Times New Roman" >  </FONT><B> |     </B><A HREF="index.htm" TARGET="_top" TITLE="C.O.L.O.M."><U><B>COLOM</B></U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=193 BGCOLOR="#6633FF" TEXT="#080000"> <div> <A HREF="index.htm" TARGET="_top" TITLE="C.O.L.O.M."><U><B>C.O.L.O.M.</B></U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Who is Rev S. E. Sanders?"><U><B>Who is Rev S. E. Sanders?</B></U></A></div> <div> <A HREF="id23.htm" TARGET="_top" TITLE="Ministering the Word of God"><U><B>Ministering the Word of God</B></U></A></div> <div> <A HREF="id21.htm" TARGET="_top" TITLE="Booking"><U><B>Booking</B></U></A></div> <div> <A HREF="id18.htm" TARGET="_top" TITLE="Prayer Request"><U>Prayer Request</U></A></div> <div> <A HREF="http://ncministries.com/worm.htm#http://worm.htm#" TARGET="_top" TITLE="http://ncministries.com/worm.htm#http://"><U><B>Meet Pastors Quentin & Donna Boger</B></U></A></div> </td> <td valign="top" height=390 BGCOLOR="#6633FF" TEXT="#080000"> <div> <B>Request Form</B></div> <div>  <form action="http://formmail.trellix.com/servlets/TlxMailer" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="First Name,Last Name,E-mail Address,Address1,Address2,City,State,Zip,Chuch Home,Churh Name,MailingList,Comments"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="Thank you. Your Prayer Request has been recieved and will be prayer over. Just remember their is no problem that God can't fix. May God continue to Bless YOU this day and for ever more, Rev. S. E. Sanders"><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="Prayer Request"><input type="hidden" name="tlx_EmailTo" value="Ssanders424@aol.com"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">FirstName:<br> <input type="text" name="First Name" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Last Name:<br> <input type="text" name="Last Name" size="30" maxlength="100"></td> </tr> <tr> <td align="left">E-mail Address:<br> <input type="text" name="E-mail Address" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Address Line 1:<br> <input type="text" name="Address1" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Address Line 2:<br> <input type="text" name="Address2" size="30" maxlength="100"></td> </tr> <tr> <td align="left">City:<br> <input type="text" name="City" size="30" maxlength="50"></td> </tr> <tr> <td align="left">State:<br> <input type="text" name="State" size="15" maxlength="2"></td> </tr> <tr> <td align="left">Zip:<br> <input type="text" name="Zip" size="15" maxlength="10"></td> </tr> <tr> <td align="left">Do you have a church home?:<br> <input type="text" name="Chuch Home" size="10" maxlength="2"></td> </tr> <tr> <td align="left">Church Name:<br> <input type="text" name="Churh Name" size="14" maxlength="14"></td> </tr> <tr> <td> <input type="checkbox" name="MailingList" value="yes"> Add me to your mailing list</td> </tr> <tr> <td align="left">Prayer Request:<br> <textarea name="Comments" rows="5" cols="30"></textarea></td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Send" name="tlx_send"></td> </tr> </table> </form>  </div> </td> </tr></table></body>