Printable Mail Form

Thank you for your interest in supporting Lubavitch of Montgomery County! Your support makes you an important partner in our vital task of strengthening Jewish identity, unity and commitment.

Please make out your check to Lubavitch of Montgomery County and send it to:

Lubavitch of Montgomery County

1311 Fort Washington Ave.

Fort Washington, PA 19034

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.

Thank you very much!

Rabbi Shaya Deitsch
Director, Lubavitch of Montgomery County

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 Lubavitch of Montgomery County, in the amount of:

$18 $36 $54 $72

   $150   $180   $360   $500

   $1000   $1800   $2500   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):	______________________________________