Printable Mail Form

Thank you for your interest in supporting Chabad. 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 Heights and send it to:

Chabad Heights
664 Sterling Place.
Brooklyn, NY 11216

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 Ari Kirschenbaum 
Director

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 Heights, in the amount of:   

 $18,000 - Double Chai Supporter  $10,000 Chai Supporter  $5,400 - Supporter
 $3,600 - Founder  $1,800 - Partner  $1000 - Contributor
 $540 - Friend  $360  $180
 $100  $54 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): ______________________________________