Secure Payment Form

 

Please connect with Yaakov Plotkin at 347-880-1253 for any question you have about Kiddush
Donation Summary:

Kiddush fund
Donation Amount: $300 Basic Kiddush
$500 Mayor's Cholent Kiddush
$750 Pimpin Kiddush
Or enter an amount below.
Note:
Donor/Payer information:
Name: *
Address:
Zip:
Phone: *
Email Address: *
To be displayed in our newsletter
        In honor/In Memory of:
        Sponsored by:
Credit Card Information:
Card Type:

Name as on Card:
Card Billing Address:
Card Billing Zipcode:
Card Number:
Card Expiration Date: MMYY
Card ID (CVV2/CID) Number:
  [What is the Card ID?]
Total Charge: