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Contribute toward the purchase of gift cards for the High Holy Days toiletry drive

I'd like to contribute to following amount:

Or, I'd like to contribute another amount: $

Please enter the amount you'd like to contribute if other than listed in the dropdown above

*E-mail

*First Name

*Last Name

Account

Online Fee:

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

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Comments

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

Total: