Donate

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Thank You for sponsoring 1 month of insurance!

You selected: 1 month of insurance

Donation Amount :

$ : *

(You may edit the amount above)

1. Personal Information

First Name: *

Last Name: *

Company Name:

Address: *

City: *

State: *

Zip Code: *

Country: *

Phone Number: *

Cell Phone:

Email Address: *

2. Payment Details

Card Type: *

Card Number: *

Exp. Month: *

Exp. Year: *

Security Code: *

This is the 3 or 4 digit number printed on the back signature panel.
It is on the front of the card for American Express.

Security Image:

Please enter the letters or digits that appear in the security image CAPTCHA Image

3. Additional Information (optional)

Shul Pledge

Please Specify Other Shul

Donation Type

General Donation In Memory Of In Honor Of For The Recovery Of

Name

To have us notify them/their family a gift has been made in their name, please enter an address or email address, and your message below:

How Did You Hear About Us?

Additional Comments:

Please mail a receipt to the address above (in addition to the receipt I will receive via email).

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Flatbush Hatzoloh is a non-profit 501c3 organization.