Printed from ChabadAlexandria.org

Memorial Wall Dedication Form

Memorial Wall Dedication Form

 This is a secure form.
(Uses 128 Bit SSL Encryption to protect credit card numbers.)

Memorial Wall Plaque
Dedication Form

Cost per plaque is $360.00

Name of Deceased; Secular:

Name of Deceased; Hebrew:

Secular Day of Passing; Month/Day/Year:

Jewish Day of Passing; (if known); Month/Day Year:

Name of father of deceased; Hebrew:

Please note: We will be happy to help you convert dates from Hebrew to secular and vice versa.

Please make check payable to: Chabad Lubavitch of Alexandria-Arlington

Please mail this form to: Chabad Lubavitch of Alexandria-Arlington,
3213 Duke Street #630, Alexandria, VA 22314

 

Or you can submit this form online and pay by Credit Card below.

Enter amount here $  

Name:     
Address:
City:         State: Zip:
Phone:      Email:

               VISA MasterCard American Express

Card No.  Exp:mm/yyyy /

Card ID Number: Where's my Card ID Number?

Thank you for your generous support.
All contributions are tax deductible.

If you have any questions or concerns please contact our office
at (703) 370-2774 or email Rabbinewman@aol.com

Secure This page uses 128 bit SSL encryption to keep your data secure.