Mishloach Manot - Purim Fundraiser Project

Name*

First NameLast Name
Phone Number

Area CodePhone Number
Email*
example@example.com
I would like to send a gift to all the names on the list below ($400)I would like to choose individual names ($24 per name)

If someone included me in their list, please reciprocate and include them in my list ($24/name)
Please include names on those not on the list ($100 per name): Additional Names
Number of Additional Names
First Name and Last Name of Individuals
Subtotal

Total*

CADTotal

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country