Bais Shmuel Chabad
Annual Membership
General Donations
Children’s Program
Building Campaign
General Donations
Name
(Required)
First
Last
Email
(Required)
Phone
Address
Street Address
City
State / Province / Region
ZIP / Postal Code
General Donation
$1,800
$1,000
$770
$500
$360
$180
Other
Amount
Reason for Donation
Invoice(s)
Membership
Pledge
Sponsorship
Aliyah
Kiddush
Other
Notes
Total
Payment Method
(Required)
Credit Card
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Credit Card
American Express
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MasterCard
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Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Month
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
Year
Expiration Date
Security Code
Cardholder Name