Printable Mail Form
Thank you for your interest in supporting Chabad of Coconut Creek & W. Pompano Beach!
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 Coconut Creek & W. Pompano Beach
and send it to:
Chabad of Coconut Creek & W. Pompano Beach
7530 Lyons Rd
Coconut Creek, FL 33073
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 Yossi Gansburg
Director, Chabad of Coconut Creek & W. Pompano Beach
|
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:
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):
|
______________________________________ |
|