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Mishloach Manot Order & Payment Form

Please complete the information below. Thank you so much for your generous support of our Purim fundraiser!

	The Whole Megillah! (Gifts for the Entire Congregation)	$125.00
	The Gift of Esther! (Gifts for all Religious School Families)	$54.00
	The Gift of Mordechai (Gifts for Clergy & Staff)	$54.00
	The Gift of Purim! ($8/ea. Please put total in "Other Amount" box. You can find the congregation list at https://bit.ly/TBDMembers	$0.00

Enter the total cost of "Gifts of Purim" ($8 multiplied by # of gifts) $

If you are giving The Gift of Purim, please list all recipients:

Would you like to reciprocate gifts to anyone who has given a Gift of Purim in your honor and you have left off this order? You will be billed $8/each.

	Yes
	No

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Total:

Mishloach Manot Order & Payment Form

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

Mishloach Manot Order & Payment Form

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

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