PAYQUIQ ONLINE :: The Faster Smarter Way to Pay

Shavuot Kit

Family Information

* Family Name:

* How many children under 12 years old are there in your household?

* Child(ren)'s age(s):

Mailing address

* Street address:

Apartment / Unit #

* City

* Zip Code

* How did you find out about this event? (i.e. PJ Library email, Jewish Federation email,social media, friend. Please be as specific as possible)

Please consider making a donation to the Jewish Federation to help us continue to provide programs like PJ Library to our community.

Input donation amount: $

Account Details

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

*E-mail

*First Name

*Last Name

Payment Information

Account

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

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

Total:

Shavuot Kit

Family Information

Mailing address

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.

Shavuot Kit

Family Information

Mailing address

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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