Funds Received Submission
Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Payer Name
*
If this payment came from a 3rd party (Schwab, Fidelity, The Donors Fund, etc.), please write in the notes section the account name that it should be applied to.
Address
If new payer only
Payer Email
If available
Payment Type
*
Please Select
ACH/Wire
Cash
Check
Zelle
Amount Received
*
Date Received
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Check Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Check #
*
Designation
*
Please Select
Donation
Tuition
Other
Fund
*
Is this a new donor?
*
Yes
No
Account Number
*
Title
*
Please Select
Dr.
Dr. and Mrs.
Mr.
Mrs.
Ms.
Mr. and Mrs.
Rabbi
Rabbi and Mrs.
Rabbi and Dr.
Mr. and Dr.
Drs.
First Name
*
Last Name
*
Phone
*
-
Area Code
Phone Number
Campaign
*
Appeal
*
Solicitor
*
Please Select
Ahron Y. Wasserman
Aaron Boruch Kagan
Yosef S. Wasserman
Chezky Schonfeld
Levi Lebovitz
Other
Other Solicitor
*
Tax Deductible?
*
Yes
No
Acknowledgement Letter
Please Select
TBD
Payment Submitted By
*
Please Select
Ahron Y. Wasserman
Aaron Boruch Kagan
Yosef S. Wasserman
Chezky Schonfeld
Levi Lebovitz
Sara G. Nussbaum
Sue Hummert
Jon Neumann
Chaim Abrams
Other
Other Submitter Name
*
Notes/Context
*
Form Submitted By
*
Submit
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