Donation e-form

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Use this convienent  e-form to make a donation, using your Visa, M/C or Amex (instead of PayPal):
 
Even if you paid thru PayPal, you could submit this form to provide us with additional details or comments.
 
* Use "TAB" to move from one field to the next.
*  After completing form, don't forget to press "submit" button on bottom right corner.

Name:
Street Address & Apt #:
City / State / Zip:
Home Phone No.
Work Phone:
Email address:
I am interested in...Dedicating a Daf $120
Inserting a Shana Tova Greeting $50
Contribution (amount specified below)
Enter Total Donation amount
Enter Date and text of dedication, or text of Rosh Hashana Greeting (or you could write other comments or questions here)
I want to pay by..MasterCard
Visa Credit Card
American Express Card
I paid thru PayPal
Credit Card # (include dashes)
Expiration date: (mm/yy)
  

Al Hadaf * POB 791 * Monsey NY, 10952 *  Ph. 845-356-9114 *