Cong. F.R.E.E. KADDISH & YAHRTZEIT
SERVICES
FAX OR MAIL FORM
* Blanks marked with an asterisk
are required
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KADDISH IS BEING ORDERED BY:
Your name*: ________________________ Contact phone: ______________________ |
KADDISH IS TO BE SAID FOR: Full name: _______________________ Full Hebrew name*:_________________ Father's name: ____________________ Fathers Hebrew name*:______________ Date of death (mm/dd/yy)*: __________ Hebrew date of death: _______________ Approximate time* __________________ Relationship to you: _________________ |
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SEND CONFIRMATION LETTER AND YAHRTZEIT REMINDERS TO: Name: _____________________________ Address: ___________________________ City / State: ________________________ Zip: _______________________________ |
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KADDISH PLAN REQUESTED*:
Annual Yahrtziet $180
Daily $360 |
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I WISH TO PAY WITH*:
Visa Fill out card information box and mail or fax this form to (718) 467-2146 Check or money order Mail in this form with check payable to: Cong. F.R.E.E |
CARD INFORMATION: Name of Card*: ____________________ Billing Address*: ___________________ Address 2: ________________________ City / State*: _____________________ Zip*: ____________________________ Card Number*:____________________ Expiration (mm/yy)*:_______________ |
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