Printable Mail Form

Thank you for your interest in supporting Chabad of Port Washington! 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 Port Washington and send it to:

Chabad of Port Washington
80 Shore Rd.
Port Washington, NY 11050

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.

Help ensure a Jewish future. Include Chabad of Port Washington in your will.

Thank you very much!

Rabbi Shalom M. Paltiel
Director, Chabad of Port Washington

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 Port Washington, in the amount 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. (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):	______________________________________