Name:     
Address:
City:         
State:      
Zip Code:

Home Telephone Number:
Work Telephone Number:
Cell Number:

E-Mail Address:

Number of Men Seats:     (Age 22+)
Names & Addresses for Each Men's Ticket
 

Number of Women Seats:    (Age 22+)
Names & Addresses for Each Women's Ticket
 


Number of Student Male Seats:   
Names & Addresses for Each Student Young Men's Ticket
 

Number of Student Female Seats:   
Names & Addresses for Each Student Young Ladie's Ticket
 

B'nai Israel Congregation Seating Committee will try to accommodate Special Requests for seating. Please understand that due to limited space we can not always accommodate everyone.
 
Specify any special request:

High Holiday Honors:

Total Amount of Donation:

Please make sure that once you fill out the form, you click on the Gray Submit button at the bottom of the form. Then please scroll down to the Donation Payment button for Google Checkout. Fill in the appropriate donation amount  and then click on the Donate Google checkout Button. This will take you to the Google Checkout secure web page. Complete your transaction on the Google Secure Website.

     

 

NEW: Automatic Credit Card Payments are now available. You can now elect to have your credit card charged on a regular basis of weekly, bi-weekly, semi-monthly, monthly, quarterly, semi-annually, or annually. This optional feature allows you to donate on a regular basis or to spread out your donation over a period of time. To elect this option please download, print and send to B'nai Israel Congregation by mail or fax the Automatic Credit Card Billing Authorization Form.
 

B'nai Israel Congregation is now accepting Credit Card Payment via secure server from an e-mailed invoice Pledge invoice. Credit cards can also be used to pay for a donation via telephone by calling the office. You can now call the office and make a pledge and with a valid e-mail address and your donation Pledge invoice will be mailed to you with the ability to pay online at your convenience.