Printable Mail Form

Thank you for your interest in supporting Chabad of the Five Towns - North Woodmere! Your support makes you an important partner in our vital task of strengthening Jewish identity, unity and commitment.

Please make out your check to Chabad of the Five Towns and send it to:

Chabad of the Five Towns
74 Maple. Ave.
Cedarhurst, NY 11516

If you'd like to give us more specific information or would like to give us your credit card information by mail, please print and fill out the form below and send it to the same address.

Thank you very much!

Rabbi Zalman Wolowik
Director, Chabad of the Five Towns

Payment Method:

Enclosed is my check
Please charge my credit or debit card account using the information provided below.

I'm happy to make a tax-deductible contribution to Chabad of the Five Towns of:

$18 Chai $36 Double Chai $54 Triple Chai $72 Associate

$150 Friend $180 Sponsor $360 Patron $500 Benefactor

$1000 Partner $1800 Chai Partner $2500 Partner Other ____________

MasterCard VISA American Express

Card Number: ________-_________-_________-_________ Exp. Date (mm/yy) ______/______

Please contact me to set up a meeting


Your First & Last Name:	______________________________________
Address:	______________________________________
	______________________________________
City, State, Zip:	______________________________________
Country (if outside U.S.A.):	______________________________________
E-Mail address:	______________________________________
Daytime Phone:	(____)______________________
Evening Phone:	(____)______________________

If you would you like this gift to be a tribute, please answer the following:

SELECT ONE.

This gift is...
In Memory of
In Honor of

To Mark a Special Occasion:
Birthday
Bar/Bat Mitzvah
Anniversary
Other _____________

Honoree's Name:

_____________________________________

To have notification card(s) sent, please complete the following.

I would like a notification card without the gift amount mailed to:

Name:	______________________________________
Address:	______________________________________
	______________________________________
City, State, Zip:	______________________________________
Country (if outside U.S.A.):	______________________________________
From (Your name as you would like it to appear on the card):	______________________________________

I would like a second notification card without the gift amount mailed to:

Name:	______________________________________
Address:	______________________________________
	______________________________________
City, State, Zip:	______________________________________
Country (if outside U.S.A.):	______________________________________
From (Your name as you would like it to appear on the card):	______________________________________