Payment Form

Payment Information

Yes! I would like to join the family of Kiddush Club Members

Amount

$250 - Kiddush Club Member
Other

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Please charge this card monthly for 12 months.

Contact Information

Title

First

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Last

*

Address

*

City

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State

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Zip

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Phone

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Email

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Credit Card Information

Type

*

Number

*

Expiration

*

*

Code

*

Use contact info above.

Name

*

Address

*

Zip

*

Kiddush Details

Kiddush Date

Honor

Memory