Pledge Payment Form

Title *
 First Name *
 Last Name *
 
 Business Name
 CC Billing Address Line 1 *
 Address Line 2
 City *
 State *
 Zip *
 Country *
 CC billing phone number *
 E Mail *
This is my home  business address

* Denotes required field:

Please direct my payment towards my existing pledge for:

 Banquet        $
 Building         $
 Aliyah            $
 Kiddush         $
 High Holiday   $
 Friday Night Dinner   $
 Phone-A-thon $
 Other             $  
  
 Account Number (from statement) 

 Security: Chabad of the Valley uses technology that encrypts all information from the end-user to the web server. This is known as SSL encryption. In fact we use the highest form of this encryption, 128 bit SSL encryption. Secure pages are identified by the "lock" icon in your browser and by the web address beginning with "https://"

Payment:

  

  Card Type * 
$  Amount *
 Card Number *     Security code *
            (3 digits on back of Visa/MC/Discover or 4 digits on front of Amex)

    Expiration Date *

Tax Reciept:

Chabad of the Valley Inc. is a non-profit organization. All grants and charitable contributions, are tax-deductible to the full extent of the law. A Tax receipt will be issued and mailed to the above name and address unless otherwise noted in the comments below. Thank you for your support.