I wish to donate Machzorim to Chevrei Tzedek for the donation fee of $36.00 each.  Enclosed is my check to Chevrei Tzedek.

Please mark the Machzorim bookplate(s) as follows: 

In memory of _______________________ by ________________________________ 

In memory of _______________________ by ________________________________ 

In honor of _________________________ by ________________________________ 

In honor of _________________________ by _______________________________ 

(Use additional sheets of paper if you wish or write neatly on the back.) 

If you prefer some other wording, please designate below. 

______________________________________________________________________ 

______________________________________________________________________ 

Please print clearly! 

I am donating a total of # ______________ Machzorim, and therefore, my check for 

__________Machzorim X $_________ = $____________is enclosed. 
 
NAME: ___________________________ 

ADDRESS: _________________________ 

                _________________________ 

                 _________________________ 

PHONE (if we need to check spelling) ____________________ 

EMAIL: _______________________________