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ב"ה

Chabad of UCR Parents

Protect Your Child. Send Them a Mezuzah.

Your Info
Name*

First Name Last Name
E-mail*
Phone number

Area Code Phone Number
Your Child's Info
Name*

First Name Last Name
E-mail*
Phone Number

Area Code Phone Number
Dorm/House Address*
Number of mezuzahs* $36 each
Payment Info
Name on card*

First Name Last Name
Card number*
Expiration Date (mm/yyyy)*
Security code*

Billing Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

100% of the proceeds of this donation or payment benefit Chabad Jewish Community Center of Riverside.
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