Donation Amount: $
Name on Card:
Visa, MasterCard or American Express
I, the undersigned agree, understand and authorize the amount shown above to be charged to my credit card. I understand these charges will appear on my credit card statement under the business name: Congregation Beis Shmuel Chabad and I accept full financial responsibility for payment of this order. I agree that payments are non-refundable and no goods or services have been received in exchange for the donation.
בית שמואל—חב"ד ע"ש ר' שמואל –מולע– מאצקין ע"ה
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