DONOR INFORMATION
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First Name:
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Last Name:
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Email Receipt?
DONATION DETAILS
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Description:
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Donation Amount
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$1.00 every Erev Shabbos
$5.00
$10.00
$15.00
$18.00
$26.00
$36.00
$54.00
$72.00
$100.00
$101.00
$180.00
$260.00
$360.00
Other
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Recurring Donation?
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Recurring Frequency
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3 Months
6 Months
12 Months
18 Months
24 Months
36 Months
Recurring payments will start one month from today's date.
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PAYMENT INFORMATION
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Card Number:
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Card Expiration Date (MMYY):
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Card ID (CVV2/CID) Number:
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