Order Form for Customized TV Commercial

The UCC’s Proclamation, Identity and Communication Ministry will provide text customization of the current television commercial. Please take the time to fill out this form.

Contact person: (Rev./Dr./Ms./Mrs./Mr.): ____________________________________________

Church Name: _________________________________________________________________

Street Address: _________________________________________________________________

City, State, Zip: ________________________________________________________________

Phone: _______________________________________________________________________

E-mail: _______________________________________________________________________

Did you or your church purchase the Still Speaking Identity Kit? Yes No

HOW SOON DO YOU NEED YOUR COMMERCIAL? _____________________________

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Information to appear on-screen: There are only two lines for personalized information. We ask that you limit your information to:

1) your church’s name

2) your church’s website OR phone number

PLEASE PRINT LEGIBLY!!

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We will supply you with a VHS tape for your personal use along with a BETA copy for the televison station. Cost of the commercial is $150. The commercial will be sent, overnight, to the address you provided above by Fed-Ex at no charge to you. An invoice for the $150 will accompany the tapes.

Mail or fax this completed form to: United Church of Christ, PIC, 8th Floor

ATTN: Gayle Elizabeth Starling

700 Prospect Avenue, Cleveland, OH 44115-1100

Phone: 866.822.8224, extension 2179

FAX: 216.736.2223

E-mail: starling@ucc.org