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Payment/Donation Form

Payment/Donation Form

 

 Secure Payment Form

To make a donation or payment, please complete this form.

 


(An asterisk *  indicates a required field)


1. Payment Type

*This Payment is  
 

*This Donation or Payment is for: 
(Please specify if necessary.  For example, High Holiday Donation, In Honor/Memory of, General Contribution, Payment for Mezuzahs, Camp Tuition, etc.)


2. Billing Information

First Name*       Last Name*
Address*    
(Please use the address associated with the credit card you will be using.)
City*        State*    Zip*   
Phone*     Email


3. Method 

Card type:            
Credit Card Number    Expires (mm/yy)  

4. Amount


$18        $36        $50       $72       $90        $108            

$180      $360     $540     $720     Other $ 

 


5. Recurring Payment Option


You may choose to have this payment scheduled as a monthly payment. This is useful for monthly donations, Hebrew School tuition payments, etc.

If you elect to do so, the amount you indicate will automatically be charged to your credit card at the beginning of each month for the duration you choose.

 

Would you like this payment to be monthly?   Yes     No

First Month      Year 

Last Month      Year 

 


6. Additional Notes

Please include any additional information about this payment here .


7. Make Payment

Please review all of your entries carefully. Once you've done so, click the 'Submit' button.
This form is safe and secure for credit card payments.

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