Printable Mail Form

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 of Madison of 

  $18 Chai     $36 Double Chai     $54 Triple Chai    $72 Associate  

  $150 Friend      $180 Sponsor      $360 Patron      $500 Benefactor  
     
  $1000 Partner    $1800 Chai Partner   $2500 Pillar    $____Matana

Please use my contribution towards

___ communtiy services   ___ Mikvah Chaya Mushka                                     ___ youth programs        ___ campus activities   ___ other _______________

  MasterCard    VISA     American Express 

Card Number:  ________-_________-_________-_________   Exp. Date (mm/yy) ______/______

 Please contact me to set up a meeting

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:

_____________________________________