Brit Tzedek v'Shalom

Jewish Alliance for Justice and Peace

DONATION FORM
Please help during the current Mideast Crisis.
Full Name
Address
Street: ___________________________ City:
_____________________
State: ____________________ Zip Code: _____________________
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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Brit Tzedek v'Shalom, the Jewish Alliance for Justice and Peace - 11 E. Adams, Suite 707 - Chicago, IL 60603
Ph: (312) 341-1205 - Fax: (312) 341-1206 - info@btvshalom.org