Payment Form

Contact Information

First

Last

Address

City

State

Zip

Phone

Payment Details

Select Amount

$72 - 4 x Chai
Sponsor a child for a day
$360 - 20 x Chai
Sponsor a child for one week
$1,440 - 80 x Chai
Sponsor a child for the summer
$54 - 3 x Chai
Sponsor Shabbos Party
Other

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Comments

Type

Number

Expiration

Code

Use contact info above.

Name

Address

Zip