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Payment Form

Payment Form

Chabad Central Hebrew School Payment Form

 

Student's Name:

Balance from Statement:

 

I understand that my credit card will be charged in equal installments  beginning on the date this form is submitted.

Please charge my credit for the full amount due.

I will be submitting a check for the full amount and/or checks divided over  one dated for now and the others postdated.

 

PAYMENT INFORMATION:

Credit Card

Name:

Street address:

City, State, Zip:

Phone Number:

Amount to charge:

Name on Card:

Credit card number:

Expiration Date:

Authorized Signature: (type in name)

Checks can be mailed to: Chabad of Boca Raton 17950 Military Trail Boca Raton, FL 33496

 

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