Marriage/Nikah Service Request Form
Assalamu alaikum wa rahmatullah.Thank you for choosing the Islamic Organization of the Southern Tier (IOST) for your Nikah (marriage). Please complete this form with accurate information so we may serve you in the most respectful and effective manner. An IOST representative will contact you to confirm your request.
🤵 Groom Information
Groom’s Full Name
*
First Name
Last Name
Groom’s Fathers Name
*
First Name
Last Name
Groom’s Mothers Name
*
First Name
Last Name
Groom’s Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Groom’s Occupation
*
Groom’s Email
*
example@example.com
Groom’s Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Groom’s Address
*
Street Address 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
👰 Bride Information
Bride’s Full Name
*
First Name
Last Name
Bride’s Fathers Name
*
First Name
Last Name
Bride’s Mothers Name
*
First Name
Last Name
Bride’s Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Bride’s Occupation
*
Bride’s Email
*
example@example.com
Bride’s Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Bride’s Address
*
Street Address Line 2
City
State / Province
Postal / Zip Code
📅 Nikah (Marriage Ceremony) Details
Proposed Nikah Date & Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Mahr Details & Agreement
*
Preferred Nikkah Type
*
Nikkah at Center with Guests — $300
Nikkah with Food — $800
Nikkah outside IOST — $600
*
I confirm the information provided is accurate. I understand service charges and possible additional fees may apply, and no payment is required at submission.
Submit
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