Shevet Pisga Payment
Parent Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Reason for Payment
*
Account Balance
Installment Payment
Donation/fundraising
shirts
Sweatshirt Winter
Camp
Payment
*
prev
next
( X )
Banner Donation From
$
500.00
Donation Amount
Banner $500
Banner $750
Banner $1000
Banner $1250
Banner $1500
Banner $2000
Banner $2500
Banner $3000
Khaki Shirt
$
15.00
Quantity
1
2
3
4
5
6
7
8
9
10
Shirt Size
Child S
Child M
Child L
Adult S
Adult M
Adult L
Adult XL
White Shirt
$
15.00
Quantity
1
2
3
4
5
6
7
8
9
10
Shirt Size
Child S
Child M
Child L
Adult S
Adult M
Adult L
Adult XL
Payment Plan
$
200.00
Balance payment
$
360.00
Subtotal
$
0.00
Tax
$
0.00
Total
$
0.00
Submit
Should be Empty: