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Name

First Last

Address

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Phone

Email*

Recipient Information (if applicable)

Do you want us to send someone a letter acknowledging your contribution on their behalf?

No acknowledgment is necessary.
Yes - please E-MAIL an acknowledgment using the email address indicated below.
Yes - please MAIL an acknowledgment to the name(s)/address indicated below.

Name

First Last

Address

Street Address City State ZIP Code

Email

Contribution Details

Type of contribution

Amount of contribution

I would like my contribution to appear as follows in the acknowledgment and in the Pardes P'Shat

Examples: In honor of [name} on the birth of their daughter, by [your name].
In honor of [name] on the Bar Mitzvah of their son, [name], by [your name].
In memory of [insert name] by [your name].

Notes

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Billing Address*

Street Address Address Line 2 City State ZIP Code

Credit Card Number*

Expiration Date*

Expiration Year*

Security Code*

Last 3 or 4 numbers on the back of your credit card.

Total

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Contribution Details

Payment using Internet Secure