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Donation to Congregation Shaarey Tphiloh Genral Fund

BILLING INFORMATION:

*Your First Name:


*Your Last Name:


*Your Email Address :


*Your Phone Number (Including Area Code) :
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*Your Address 1 :


Address 2 :


*Your City:


*Your State :


*Zip Code :


*Amount to be Donated to Shaarey Tphiloh General Fund (Numbers only please):



DONATION DEDICATION (NOTE: Only one of the two options can be chosen)

Click this box if you would like to dedicate this donation in an individual(s) memory and fill out the dedication information below


Dedicated in memory of :

Click this box if you would like to dedicate this donation in an individual(s) honor and fill out the dedication information below


Dedicated in honor of :

DONATION NOTICE CONTACT INFORMATION:

Check this box if you wold like us to send out a notification of your donation and enter the mailing information in the box below (the name, address, state and zip code of the individual you would like us to send the notice to):