Donation Form

This form can be used for general donations as well as ordering Tree of Life or Yahrzeit plaques. Please follow the instructions below. Once the form is complete, you will be directed to PayPal for payment. You can use a debit/credit card or pay from your existing PayPal account. You do not have to have a PayPal account to use this form. You can submit with just a credit/debit card.

If you prefer to mail in your donation, please click here in order to download/print a paper form.

Donor Name *

First

Last

Donor Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Donor Email *

Email

Confirm Email

Donor Phone *

Would you like to donate anonymously? *

• Yes
• No

Do you want to receive an acknowledgment letter? *

• Yes
• No

Please choose your type(s) of donation(s):

• General Donation (you may specify fund)
• Donation in Honor of Rabbi’s 25th Anniversary
• Tree of Life Leaf or Stone
• Yahrzeit Plaque for Memorial in Sanctuary
• Host an Oneg

Please choose where to direct the donation: *

• General (for CKA Operating Expenses) – Unrestricted Fund
• Rabbi’s Discretionary Fund – Restricted Fund
• Religious School/Education Fund – Restricted Fund
• Building Fund – Restricted Fund
• Youth Group – Restricted Fund
• High Holiday Fund (includes security/choir/childcare) – Restricted Fund

Restricted Fund indicates the monies can only be spent on the specific area indicated. Unrestricted Funds may be allocated at the owner’s discretion.

In Memory of:

In Honor Of:

General Donation

Enter your donation amount here Please use this if you are making a non-specific, general donation to one of our various donation funds.

Donation in Honor of Rabbi's 25th Anniversary

Enter your donation amount here.

Host an Oneg

Please enter the amount here if you would like to Host an Oneg. Our current minimum donation to Host an Oneg is $60.

Minimum Price: $60.00

Requested Wording for Tree of Life: *

Suggested Wording: “In Honor of…” “On the Occasion of…” “To Thank and Recognize…”

Tree of Life

Please enter your donation amount for a Leaf. A minimum donation of $126 is required for a Tree of Life Leaf. A minimum donation of $1008 is required for a Tree of Life Stone. We request that you do not use the Tree of Life for memorials. If you would like to do a memorial, please use a Yahrzeit plaque.

Minimum Price: $126.00

Name of Deceased *

First

Middle

Last

Date of Death *

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Hebrew Date

Relationship to Donor *

Yahrzeit Plaque

Please enter your donation amount for a Plaque. A minumum donation of $250 is required for Yahrzeit Plaques.

Minimum Price: $250.00

Would you like to notify a 2nd party of your donation? *

• Yes
• No

Please acknowledge donation to 2nd party:

First

Last

Address

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Additional Comments or Instructions

Would you like to donate an additional 3% to help cover credit card processing fees? *

• Yes
• No

As a non-profit, we are always trying to reduce our costs as much as possible. If you would like to help with his effort, please consider donating at extra 3% to help cover the fees we will incur from our credit card processor.

Donation for Credit Card Fee

Price: $0.00

Total

Order Summary

Item	Quantity	Total
There are no products selected.
General Donation	1	$0.00
Donation in Honor of Rabbi’s 25th Anniversary	1	$0.00
Host an Oneg	1	$0.00
Tree of Life	1	$0.00
Yahrzeit Plaque	1	$0.00
Donation for Credit Card Fee	1	$0.00
Total		$0.00

$0.00

PayPal Commerce *

PayPal CheckoutCredit Card

Card Number

Expiration Date

Security Code

Card Holder Name

Message

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