GRACE BIBLE CENTER
Donation Information                                   
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                                                          Referred By_________________
                                                          GBC Rep _LEAVE BLANK_____
                                                           Confirmation # ________
                                          Appointment Date & Time________  ______
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PROGRAMS WE OFFER
IMPORTANT NOTICE:

PLEASE NOTE: THE INFORMATION WE HAVE REQUESTED WILL NOT BE DISCLOSED TO ANYONE.  
THIS INFORMATION IS FOR OUR PURPOSES ONLY.  WE ASK YOU THIS INFORMATION TO KNOW
WHAT SERVICES WE MAY BE ABLE TO ASSIST YOU WITH.  IF YOU NEED ANY SERVICES THAT WE
DID NOT MENTION, PLEASE FEEL FREE TO WRITE IT DOWN AND WE WILL USE OUR RESOURCES
TO ASSIST YOU. PLEASE CHECK ON ANY PROGRAMS THAT MAY INTEREST YOU.
DO YOU KNOW ANYONE ELSE THAT COULD USE OUR SERVICES? GIVE THEM A CALL AND LET
THEM KNOW ABOUT OUR SERVICES.
DISCLAIMER: Grace Bible Center’s commitment of excellence to you is pursuant to the Federal Bill
Emerson Good Samaritan Food Donation Act. In addition, foods that are received from our Donors
are carefully wrapped and/or packaged. Foods that we deliver to you, is neither outdated, nor
expired. Foods that we receive into our facility are carefully stored to meet compliances within the
Federal Bill Emerson Good Samaritan Food Donation Act. Therefore, Donee shall be liable for its
own acts of negligence, and Donee shall hold Grace Bible Center harmless and indemnify Grace
Bible Center for any loss, cost, expense, or
liability, including (attorney fees) incurred by Grace Bible Center as a result of Donee’s negligence
in the deliverance and/or reception of its food products.

PLEASE ACKNOWLEDGE YOUR AGREEMENT OF THIS DISCLAIMER BY SUBMITTING YOUR
SIGNATURE IN THE BOX BELOW.

TYPE YOUR NAME IN THE BOX                                                                                                            
1)        DO YOU HAVE A RELATIONSHIP WITH JESUS CHRIST OUR LORD AND SAVIOR?
(If YES, then skip down to #3                  (If NO;) read the following:

Romans 10:9-10 says

That if thou shalt confess with thy mouth the Lord Jesus, and shalt believe in thine heart that God
hath raised him from the dead, thou shalt be saved.

For with the heart man believeth unto righteousness; and with the mouth confession is made unto
salvation.

Additionally,  

Ephesians 2:8-9 says,  
For by grace are ye saved through faith; and that not of yourselves: it is the gift of God:

Not of works, lest any man should boast.

2)        WOULD YOU LIKE FOR US TO LEAD YOU TO CHRIST?
NO; then skip down to #3

YES  (Then READ AFTER THE FOLLOWING)

Father, I am a guilty sinner………………I need Christ help………………Lord, come into my life………….
and take full ownership with authority over my soul……… I accept you…………… with all my
being……….. into my heart………………………You said, in Romans 10:9-10

That if thou…….. shalt confess with thy mouth………….. the Lord Jesus,…….. and shalt believe in
thine heart…………….that God hath raised him from the dead,…………… thou shalt be saved and

For with the heart man believeth…………….unto righteousness;…………. and with the mouth………..
confession……….. is made unto salvation.

Therefore,……. I’m confessing and believing………… that you are the Christ……..whom gives eternal
life…... Additionally, you said in Ephesians 2:8-9

For by grace are ye saved……….through faith;…………and that not of yourselves:…………it is the gift
of God:

Not of works,………….lest any man should boast.

Therefore,………….I receive my eternal gift of salvation………Thank you Jesus

What you have confessed here today....through reading out of your mouth, and believed in your
heart, the bible says that you are eternally saved and that...will never be erased.

   Congratulations……………  We will contact you to help you along this journey.

JUST ONE MORE THING

3)        ARE YOU WILLING TO GIVE A TESTIMONY ABOUT OUR CHURCH FOOD FEEDING PROGRAM FOR
OUR WEBSITE?   IF SO, PLEASE LET US KNOW.

THANK YOU FOR VISITING GRACE BIBLE CENTER.  SOMEONE WILL GIVE YOU A CALL TODAY TO
SCHEDULE THE DATE AND TIME TO PICK UP YOUR FREE FOOD.


BE SURE TO CHECK OUR WEBSITE FOR OUR WEEKLY COMMUNITY CHEST SPECIALS
PLEASE BE SURE TO READ THE FOOD PICK UP
RULES PRIOR TO SCHEDULING YOUR
APPOINTMENT.