Building Fund Member - Single Subscription

נא למלא את פרטי הטופס המצורף לתכנית Building Fund Member - Single

Family/Single Last Name *

Husband First Name

Wife First Name

Husband Hebrew Name

Wife Hebrew Name

Husband Jewish Name

Husband Father Jewish Name

Husband Mother Jewish Name

Wife Jewish Name

Wife Mother Jewish Name

Children

Group (Kohen, Levi, Yisrael)

Home Phone

Husband's Cell Phone

Wife Cell Phone

Husband's Email

Wife's Email

Address

City *

Zip

Bar Mitzva Parsha

Yahrzeit Husband's Father

Yahrzeit Husband's Mother

Yahrzeit Wife's Father

Yahrzeit Wife's Mother

Date Joined

Yahrzeit Other

Hebrew Date Birthday - Wife

Hebrew Date Birthday - Husband

Payment Information

Payment Terms

850.00₪ for each year

Regular subscription price

₪

Regular subscription discount amount

₪

Regular subscription tax

₪

Payment Fee

₪

Regular gross amount

₪

Payment Method *

Cash, Check, Bank Transfer - Mizrahi Tefahot, Bank #20, Snif #521, Account # 136396

Paypal - please add 4% service fee

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

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Building Fund Member - Single Subscription

Payment Information