Chabad on Campus International Gemach - Guarantor Form

Chabad on Campus International Gemach - Guarantor Form
Name*

FirstLast
Cell*

Area CodePhone Number
Email*
Relationship to borrower*
I am guaranteeing on a loan amount of*
I am guaranteeing a loan that is being awarded to: (Please enter appropriate Shliach or Shlucha name:*

First NameLast Name

A $1 will hold will be put on the credit card which will be released in 7 -14 business days.*

Credit card for loan guarantee $1.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Terms & Conditions
I agree to provide COCI with credit card information that will be charged in full in the event that the borrower’s payments are declined/returned.*

Yes
Any questions pertaining to the above terms can be directed to Nechoma Dina Dubrowski at ndd@chabad.edu or 718-510-8181 ext. 107.
Please sign here, I have read and agree to all the Gemach Terms & Conditions *

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