Payment Information
Yes! I would like to support the activies of Chabad
Amount
$50 - Friend
$72 - Associate
$108 - Donor
$180 - Sponsor
$360 - Patron
$500 - Leader
$1,000 - Builder
$1,800 - Supporter
$3,600 - Founder
$5,400 - Chairman
Other
*
Please charge this card monthly for 12 months.
Contact Information
Title
Title
Mr.
Mrs.
Ms.
Dr.
Mr. & Mrs.
Dr. & Mrs.
Rabbi
Rabbi & Mrs.
First
*
Last
*
Address
*
City
*
State
*
Zip
*
Phone
*
Email
*
Credit Card Information
Type
Card Type
Visa
MC
Amex
Discover
*
Number
*
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
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
*
Code
*
Use contact info above.
Name
*
Address
*
Zip
*
Other Information
Please contact me to discuss other giving oportunities.
Comments
Honor
Memory
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