Shirdi Sai Temple Chicago Free Gift Request Form
To get free NTSC DVD (packaging, shipping and handling charges extra) of Sai Bhajans submit form securely online or print form and mail or fax or call. See instructions below
Section 1. Your Details Note:(*) indicates required fields             Watch Sample Clip
         (+) indicates required fields if paying online by credit card.
First Name:  *
Last Name:  *
Street Address One:  *
Street Address Two:
City: *
State: *
Zip: *
Country: *
Home or Cellphone Number: *
Day or Workphone Number:
E-Mail Address: *
Select NTSC DVD Gift Option: *
Section 2.  Packing, Shipping and Handling (P,S&H) Charges and Donation (if any) details:
P,S&H charges for each DVD are $5.00 within USA, $9.00 to Canada and $11.00 to other countries by global priority mail. Visitors from outside USA and Canada, please verify that you can play NTSC format in your DVD player before ordering
A. Enter your P,S&H and donation in USD: +
B. Select Payment Method: Check Credit Card     +
C. For Credit Card Payments:
Check the Type of Credit Card : Visa Master Card
American Express Discover +
Enter your Credit Card Number: +
Enter Credit Card Holder’s Name: +
Enter Credit Card Expiration Date:(mm/dd/yy or mm/yy format) +
 
I hereby authorize Shirdi Sai Baba Sanstha, to bill my Credit Card as shown above for the donation amount listed above and I promise to pay such amount subject to and in accordance with the agreement governing the use of such card.
Section 3.  Write comments if any, sign and date form:
Write comments if any:
Signature: * Date:(mm/dd/yyyy format) *

To donate by Credit Card, fill the form and hit the submit button. When you submit, your information will be securely transmitted over the internet using SSL encryption. Alternatively you can fax completed form to : (847) 931-4066.

To donate by Check make check payable to "Shirdi Sai Baba Sanstha", print and fill this form and please mail along with check to Shirdi Sai Temple, 12N950 IL Route 47, Hampshire, IL 60140, USA. or call (847) 931 4058 for questions if any.

Donations if made in USA are tax deductible under IRS section 501(c)(3). Tax ID 36-4400449. Please consult your tax advisor for details and eligibility

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