Brit Tzedek v'ShalomJewish Alliance for Justice and Peace |
DONATION FORM
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| Please help during the current Mideast Crisis. | |||||||||
| Full Name | |||||||||
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| Address |
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| Phone Number | Home: _______________________ Cell: _________________________ | ||||||||
| Email Address | |||||||||
| Donation Amount | ___ $50 ___ $100 ___ $200 ___ $500 ___ Other | ||||||||
| Charge my | ___Master Card ___Visa | ||||||||
| Card Number | |||||||||
| Amount and Expiration | Amount $_______ Expiration Date:____/______ | ||||||||
| Name on Credit Card | ___________________________________ (PLEASE PRINT CLEARLY) | ||||||||
| Submit this form with payment via mail or fax to: Brit Tzedek v'Shalom, The Jewish Alliance for Justice and Peace 11 E. Adams Street, Suite 707 Chicago, IL 60603-6326 Fax: (312) 341-1206 |
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