Prayer Request Form

Name *

Email Address *

City *

State *

Zip Code

Country *

Phone Number ( optional)

What is your prayer request *

How did you hear about us? *

Not required, but you have the opportunity to receive the anointed prayer cloth for a $15.00 seed offering to help us cover administration costs. *

No I am not interested at this time, I just need prayer.

Yes, please contact me and I will make a love offering.

I have already completed the other form and made a love offering to receive as a thank you gift the anointed prayer cloth and the healing e-book.