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. 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)
• Mitzvah Magic Capital Campaign
• Tree of Life Leaf or Stone
• Yahrzeit Plaque for Memorial in Sanctuary

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.

Mitzvah Magic Donation

Please enter the amount you would like to donate for the Mitzvah Magic Capital Campaign.

Minimum Price: $10.00

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 *

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

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 Qty	Total
There are no products selected.
General Donation	1	$0.00
Mitzvah Magic Donation	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

Name

Make Donation