Temple Har Shalom Donation Form

Donor Information

Salutation

First Name

Last Name

Phone

Select the fund to which you would like to donate

Amount

Would you like to make this gift a tribute in honor or in memory of someone?

Type

Salutation

Honor/Memorial Name

Honor/Memorial Message

Is the tribute recipient a member?

Person to Notify

Notification Address

City

State

Zip Code

I would like to make my gift recurring

Recurring Payments

Frequency

Number of Payments

Total Gift

This is the Amount * Number of Payments

Payment options

ACH/eCheck Billing

Bank Routing Number

Bank Name

Bank Account Number

Account Holder Name

Bank Account Type

Credit Card Billing

Credit Card No.

Verification Code

Exp. Month

Exp. Year

YYYY

Billing Street

Billing City

Billing State

Billing Zip Code

Billing Country