Har Shalom Donation Form - "Bill to Account" ONLY - Form

Har Shalom Donation Form - "Bill to Account" ONLY

PLEASE LOGIN TO ENSURE PROPER ASSOCIATION OF PAYMENT TO YOUR ACCOUNT. Enter the name on your Har Shalom Account in the field indicated (below).

NOTE: This form should ONLY be used for Donations you wish to "Bill to Account." All other contributions should be made at www.HarShalom.org/payment.php.

DONOR INFORMATION

* Donor First Name

* Donor Last Name

Donor Email

(Will be used for confirmation)

How you wish to be listed:

Please check this box if the donor wishes to remain anonymous

Please check this box if the donor wishes to remain anonymousAll donations will appear in The Tablet (our bi-monthly newsletter) unless requested otherwise.

* Donor Address

* Donor Address City

* Donor Address State

* Donor Address Zipcode

DONATION & DEDICATION INFORMATION

Dedication Type

In Memory ofIn Honor ofSpeedy Recovery to

Dedication Notes

Please include Name, relationship, special occasion, etc.

Example: In Memory of Joan (mother), On the occasion of Bob's 60th Birthday, etc.

Person to Notify (Honoree)

Honoree Address

Honoree Address City

Honoree Address State

Honoree Address Zipcode

PLEASE ATTRIBUTE THIS DONATION TO...

Please Select One

Amount

Click HERE for full descriptions of Har Shalom Funds

Thank you for your generous support!

Wed, April 24 2024 16 Nisan 5784