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YOUR INFORMATION
First name   State
Last name   Zip
Address   Email
City   Phone
 
I WOULD LIKE TO CONTRIBUTE
10,000 5,000 1,800 500 360
180 72 36 Other

Become a part of the Chai Club! Please consider becoming a monthly partner
I would also like to contribute on a monthly basis.

Please designate contribution for
Make a donation for a designated program or event

In Memory/Honor of .
Make a donation in honor of someone who has inspired you or in memory of a deceased family member or friend.

I would like to remain anonymous
PAYMENT DETAILS
(Alternatively you may print this form and mail with a check to Chabad of Larchmont, 921 W. Boston Post Road• Mamaroneck, NY 10543.)
Name on card   Amount to be charged
Card Number   Card Type
Exp. Date   CVV Code 3 digits on back of card

Thank you for your generous support. All contributions are Tax-deductible.

We also accept cars, stocks and in kind donations.

Click here for information about our Yahrtzeit Memorial Board

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