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Donation Form (MONTHLY)
Please note, this form is for setting up a
Monthly
charge that will automatically be billed to the credit card you provide. To make changes you must
contact the office
.
Click here if you'd like to make a one-time payment / donation
Donor Information
*
First Name
*
Last Name
*
E-Mail Address
Phone Number
*
Mailing Address:
*
City
*
State
*
Zip/Postal Code
*
Country
Years at Yeshiva
Amount Paid Every Month
Please select the amount you would like charged every month.
Additional Comments and/or Receipt Instructions
Donation Amount
Other Amount
$72
$100
$180
$250
$360
$500
$1,000
$1,800
$2,500
$3,600
$5,000
$10,000
Monthly Charges Total
$
0
Monthly
Payment Details
Amount Charged (MONTHLY)
0
Payment Method
Visa
Mastercard
American Express
Credit Card Number
Name on Card
Expiration (MMYY)
01
02
03
04
05
06
07
08
09
10
11
12
/
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
Security:
Please follow instructions below for security reasons.
