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Credit Card Info
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| Card Type* |
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| Credit Card Number* |
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| Expiration Date* |
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| Amount of money to be charged to the card* |
$ |
| CVV - 3 or 4 digit security code on back or front of card* |
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| How do you want to receive the Dollars ? |
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| Receive in person (in shul, or in school) |
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| Send with my child ( Girls Campus Only) |
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| Send via mail |
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Billing Info
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| First Name* |
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| Last Name* |
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| Address* |
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| City* |
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| State* |
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| Zip* |
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| Country |
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| |
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| Phone |
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| E-mail |
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| Please initial this field to indicate that you agree to 2.5% surcharge: |
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| Total to charge: |
$0.00 |
