Donation Amount: A Gift of Friendship $3600 A Gift of Acceptance $180 A Gift of Love $1800 A Gift of Laughter $54 A Gift of Hope $540 A Gift of Chai $36 A Gift of Compassion $360 A Gift from the Heart Other Optional In Memory of Make a donation in memory of a deceased family member or friend. In Honor of Make a donation in honor of someone who has inspired you. Name: * Denotes required field Contact Information Title* Chaplain Dr. Dr. & Mrs. Drs. Mr. Mrs. Ms. Mr. & Mrs. Rabbi Rabbi & Mrs. The Honorable First Name* Last Name* Address Line 1* Address Line 2 City* State Post Code* Country* Phone This is my home business address. Credit Card Card Type Visa Master Card American Express Card Number Expiration Date 01 02 03 04 05 06 07 08 09 10 11 12 2016 2017 2018 2019 2020 2021 2022 CVV Security Code What's This? Electronic check Name as it appears on Check Date Bank Name Bank Address Bank ABA Routing Number (9 digit number generally on the lower left of your check) Account number Your Check Number I hereby authorize Chabad of Greater Hartford to create an electronic check drawn against my account in the amount of $ Please remember to record your check in your register. Chabad will send you a written receipt for tax purposes Acknowledgement Email Address* Reconfirm Email Address* Please contact me to discuss additional giving opportunities. Recurring donation: Please charge the above amount to my credit card each month for the next twelve months. This page uses 128 bit SSL encryption to keep your data secure.
