Machon Chana - Special Programs

MISHLOACH MANOS ORDER FORM

Please complete the payment portion of this form. Checks should be mailed with this form to Machon Chana.

Name of person ordering:

Contact phone number:

Address:

City, State, Zip

Maiden Name:

Email:

Amount of cards I would like to order:

1 card $5

3 cards $14

5 cards $22

10 cards $40

25 cards $75

or

Please send the MISHLOACH MANOS cards to my address

Please send the MISHLOACH MANOS cards to the following name and addresses for a $1.00 extra each

Total amount that will be enclosed: $

I will pay by:
Check
Money order
Credit card
PayPal

If paying by credit card, which credit card are you paying with?
MasterCard
Visa
AMEX
Discover

Card Number:
Exp. date: CCV:
Name on card:

Please make checks and money orders payable to Machon Chana.
Machon Chana
556 Crown St.
Brooklyn, NY 11213
Fax: (718) 735-9175

For more information please contact Mrs. Sara Katzman at 718-735-0030 or click here to e-mail us.