Old Donate Form

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In Memory of:
Make a donation in memory of a loved one.
In Honor of:
Make a donation in honor of someone who inspired you.
Name

* Denotes required field:

Mr. & Mrs. Mr. Mrs. Miss Ms. Dr. & Mrs. Dr.Title
 First Name *
 Last Name * 
 Address (use address associated with credit card) 
 City
 State
 Postal Code
 Country
 Phone
 email
This is my home  business address

Form of payment:

               Discover      

 Card Number
01 02 03 04 05 06 07 08 09 10 11 12  2007 2008 2009 2010 2011 2012 2012 2013 2014  Expiration Date

 I will mail my check to the Chabad Jewish Center 4010 Park St North S. Petersburg FL  33709                   Please contact me to discuss additional giving opportunities

Amount:

$18         $36     $54          $90    $180    
$360      $720     $1000     other  $

Recurring donation (optional):

 Please charge the above amount to my credit card on the first day of
      each month for the following duration:

January February March April May June July August September October November December2007 2008 2009 2010 2011 2012 2013 2014 2015First month to be charged
January February March April May June July August September October November December2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 No end date!Last month to be charged

Targeted gift:
You can target your gift towards a specific program or event hosted by Chabad. Please provide any additional comments here: 

 Email address *
 Reconfirm Email Address *
 You may acknowledge my gift to my e mail address.
 Please acknowledge my gift by mail to the above street address. 

Tax Reciept:

Chabad of S. Petersburg Inc.  is a non-profit organization. All grants and charitable contributions  are tax-deductible. A tax receipt will be issued and sent to the above name and address unless otherwise noted. Thank you for you Support.

Please carefully review the information you provided,
then press Submit (once only).

Thank you!