SECURE PAYMENT FORM
IN HONOR OF
SHLOMO FISHBERG
KESSER SHEM TOV AWARD
YISROEL GEWIRTZMAN
TALMID OF THE YEAR AWARD
SHAAREI TORAH ALUMNI
RAV ELYA LOPIAN, ROSH CHABURA
MOSHE AND FAIGY BRUCKMAN
MORDECHAI AND BROCHA RIVKA CHAITOVSKY
MOSHE AND ALIZA EPSTEIN
CHAIM AND RIVKY FOGEL
ARIEL AND SUZI GOODMAN
ELI AND AHUVA GROSS
MENDY AND SARA RIVKA KATZ
YAKOV AND RIVKY KOFF
DOVID AND CHAYA AIDY LIFF
ELYA AND MALKY LOPIAN
KOEN AND LEAH MULLOKANDOV
AVROMI AND CHAVA ROCHEL REIFMAN
AKIVA AND MIRI TOPPER
YITZCHOK AND RIVKY WEINBERGER
EZZY AND LAYLA WEISS
CHAIM TZVI AND GITTY VORCHHEIMER
DONATION DETAILS
BUILDER OF TORAH....18,000
AMUD HATORAH..........10,000
DIAMOND PAGE..............5,000
GOLD PAGE......................3,600
PLATINUM PAGE............2,500
SILVER PAGE...................1,800
BRONZE PAGE.....1,000
FULL PAGE..............750
HALF PAGE..............360
QUARTER PAGE.....250
EIGHT PAGE............100
CUSTOM: $
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RESERVATIONS
I want
reservations for the following people:
YOUR INFORMATION
COMPANY NAME
FIRST NAME
LAST NAME
ADDRESS
ADDRESS LINE 2
CITY
STATE
ZIP CODE
PHONE NUMBER
EMAIL ADDRESS
PAYMENT DETAILS
TOTAL AMOUNT:
NAME ON CARD
CARD NUMBER
EXPIRATION
EXP
DATE
CVV CODE
CARD BILLING INFO
SAME AS YOUR INFORMATION
CARD BILLING ADDRESS
CITY
STATE
ZIP CODE