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Required Fields
Donation Amount
Amount
$25
$50
$75
$100
Other
Contact Information
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First Name
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Last Name
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Address
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Zip/Postal Code
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Home Phone
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Email
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Help Us Cover Costs
Simply leave "Yes!" checked below to ensure that 100% of your intended donation is available for our mission.
Yes! I want $0.00 to go to Hebrew Public and I will donate $0.00.
No. I will donate $0.00 and Hebrew Public will cover the processing costs.
Credit Card Information
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Card Holder Name
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American Express
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Card Account Number
Expiration Date
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02
03
04
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34
Security Code
The 3 or 4 digit Security Code (CVV2) can be found on the back of your credit card.
For
American Express
, the Security Code (CID) can be found on the front of the card.
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Billing Address
Same As Above
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