Contact Information
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Title
Mr.
Mrs.
Ms.
Dr.
Mr. & Mrs.
Dr. & Mrs.
Rabbi
Rabbi & Mrs.
First
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Last
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Address
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City
State
Zip
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Phone
Email
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Payment Information
Yes! I would like to support the activies of Chabad
Amount
$54
$180
$360
$770
$1,000
$1,800
Other
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I'd like to be a Chai supporter by donating the above amount monthly, for the next 12 months.
Purpose
Purpose
Eaton Fire Relief Fund
General Donation
Maftir Yonah
Chanukah
Jewish Chaplaincy Services
Shabbos Kiddush
Maos Chittim - Passover Fund
Jewish Men's Club
Miscellaneous
Year End Campaign
Private Class
Group Class
High Holiday Donation
In honor of
In memory of
Credit Card Information
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Card Type
Visa
MC
Amex
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Number
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Expiration
Month
1 - January
2 - February
3 - March
4 - April
5 - May
6 - June
7 - July
8 - August
9 - September
10 - October
11 - November
12 - December
*
Year
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
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Code
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Use contact info above.
Name
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Address
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Zip
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Other Information
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