CHAI-FIVE Campaign Donation

The High Five Campagn is all about you choosing how you want to make Temple Concord and even more wonderful place. Complete the form below to make your credit card donation. List your donation categories and units in the "Donation Description" box below.

* Total Amount Donated. $

* Your Name

* Choose

	My name will appear in the Shelanu
	I wish to donate anonymously

* Donation Designation

	See my donation descripton below...
	My donation is to the area most in need.

Donation Description

Specify the Category and Units you are donating from the Chai-Five list shown above - For Example: Mansion Porch ----- 3 units $540 Religious School: -- 2 units $360

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: