Printable Donation Form
Thank you for your interest in supporting Chabad House on Wheels! Your contribution will help us provide vital information and services to people across the globe.
Please make out your check to Chabad House on Wheels and send it to:
Chabad House on Wheels
P.O. Box 2591
Miami Beach, FL 33140
If you'd like to give us more specific information or would like to give us your credit card information by mail, please print and fill out the form below and send it to the same address.
Thank you very much!
Rabbi Zev Katz
Director, Chabad House on Wheels
Payment Method:
Enclosed is my check
Please charge my credit or debit card account using the information provided below.
I'm happy to make a tax-deductible contribution to Chabad House on Wheels of:
$__________ $500 $250 $100 $50 $25
American Express MasterCard VISA
Card Number: ________-_________-_________-_________ Exp. Date (mm/yy) ______/______
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| Your First & Last Name: | ______________________________________ |
| Address: | ______________________________________ |
| ______________________________________ | |
| City, State, Zip: | ______________________________________ |
| Country (if outside U.S.A.): |
______________________________________ |
| E-Mail address: | ______________________________________ |
| Daytime Phone: | (____)______________________ |
| Evening Phone: | (____)______________________ |
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If you would you like this gift to be a tribute, please answer the following:
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SELECT ONE. |
This gift is...
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In Memory of
To have notification card(s) sent, please complete the following.
I would like a notification card without the gift amount mailed to:
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| Name: | ______________________________________ |
| Address: | ______________________________________ |
| ______________________________________ | |
| City, State, Zip: | ______________________________________ |
| Country (if outside U.S.A.): | ______________________________________ |
| From (Your name as you would like it to appear on the card): | ______________________________________ |
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I would like a second notification card without the gift amount mailed to:
| Name: | ______________________________________ |
| Address: | ______________________________________ |
| ______________________________________ | |
| City, State, Zip: | ______________________________________ |
| Country (if outside U.S.A.): | ______________________________________ |
| From (Your name as you would like it to appear on the card): | ______________________________________________ |
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