Prayer Request

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" rowspan="2" width=168 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <A HREF="id61.htm" TARGET="_top" TITLE="Credits"><U><IMG SRC="07189810.gif" border=0 width="137" height="129" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Pastor"><U><B>About Me</B></U></A><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><A HREF="id17.htm" TARGET="_top" TITLE="Pastor"><U><B> </B></U></A></FONT></div> <bR> <div> <A HREF="id29.htm" TARGET="_top" TITLE="Pastor Photo Galley"><U><B>Photo Galley</B></U></A><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><A HREF="id29.htm" TARGET="_top" TITLE="Pastor Photo Galley"><U><B> </B></U></A></FONT></div> <bR> <div> <A HREF="id56.htm" TARGET="_top" TITLE="Message For The Week "><U><B>Message For The Week</B></U></A><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><B> </B></FONT></div> <bR> <div> <A HREF="id30.htm" TARGET="_top" TITLE="Prayer Request"><U><B>Prayer Request</B></U></A><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><A HREF="id30.htm" TARGET="_top" TITLE="Prayer Request"><U><B> </B></U></A></FONT></div> <bR> <div> <A HREF="mailto:jmhlwalls@msn.com" TARGET="_top" TITLE="mailto:jmhlwalls@msn.com"><U><B>Contact Me</B></U></A></div> <bR> </td> <td valign="top" height=462 colspan=2 BGCOLOR="#FFFFFF" TEXT="#080000" bgproperties="fixed" background="0ab00c00egerdp.jpg"> <div> Prayer  Request</div> <DIV ALIGN="LEFT"></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="FirstName,LastName,Email,Company,Address1,Address2,City,State,Zip,Phone,MailingList,Prayer Form"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="May God Bless You as We Pray for You "><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="Prayer Request"><input type="hidden" name="tlx_EmailTo" value="info@comsda.org"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">First Name:<br> <input type="text" name="FirstName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Last Name:<br> <input type="text" name="LastName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Email:<br> <input type="text" name="Email" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Company:<br> <input type="text" name="Company" 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="100"></td> </tr> <tr> <td align="left">State:<br> <input type="text" name="State" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Zip:<br> <input type="text" name="Zip" size="10" maxlength="10"></td> </tr> <tr> <td align="left">Phone Number:<br> <input type="text" name="Phone" 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 Form:<br> <textarea name="Prayer Form" 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><tr> <td valign="top" colspan=2 height=18 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> Powered & Donated By <A HREF="id61.htm" TARGET="_top" TITLE="Credits"><U>Moon Water Designs</U></A> © 2003  </div> <bR> </td> </tr></table></body>