Temple Israel Online Contribution Form
Donor Information
First Name: Middle Initial: Last Name: Email Address:
  Street Address:   Apt/PO Box:  
  City: State: Zip Code:  

Please choose from the following funds and enter amount in the box to the right of the fund:
(minimum donation $5.00 per fund unless otherwise noted; minimum contribution for credit cards is $10.00)
  Fund:     Amount: $   
  Contribution Occasion: Name:  
  Payment Method: Credit Card Number (if applicable)  
  Expiration Month: Expiration Year: Security Code:  

Recipient Information
  Send Acknowledgement To: Street Address: Apt/PO Box:  
  City: State: Zip Code:  

Additional Comments/Instructions

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Temple Israel
239 South River Street
Wilkes-Barre, PA 18702
Phone: 570.824.8927 Fax: 570.824.1537
Email Temple Israel