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Bet Aviv Donation Form

If you'd prefer to mail in a donation, please click here to download a printable form.

Donor Information

* Name

Telephone Number

E-mail Address

Address

City/State/Zip

Donation Funds

Donation Amount $

I would like to make my donation to the

	General Fund to help support the interests and activities of Bet Aviv
	Cantor's Discretionary Fund
	Marv. Hoss Adult Education Fund
	Paula Polinsky Congeniality Fund
	Rabbi's Discretionary Fund
	Richard Tobin Memorial Fund
	Arnold Feldman Social Action/Tzedakah Fund
	High Holiday Flower Fund
	Shabbat Security Fund

See the Donation page on our website for a description of the funds

My donation is

	in honor of
	in memory of
	other

Description/Message

Prayer Book Dedications

I would like to dedicate a prayer book.

Enter the number of Prayer Books

My donation is

	in honor of
	in memory of
	other

Description/Message

Who to Notify About This Donation

Name

Address

City/State/Zip

I would like to make a monthly donation

Recurring Payment

I want to make a recurring payment

Please enter the number of periods

Please bill me each period in the amount of

I agree to have my account information used to bill me as per the terms above. Additional payments will be made until the total number of periods are reached.

Recurring Total:

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

Checking Account

Name on the Account

Bank Name

Routing Number

Is usually located between the symbols on your check.

Account Number

Typically comes before the symbols. Its exact location and number of digits varies from bank to bank.

Confirm Account Number

Comments

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

Total:

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Please contact the Bet Aviv office at (410) 992-9994 if you have any questions or comments about the PAYQUIQ service or about payments.

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