5784 HH Honors Donation Form It is customary for those receiving honors to make a donation to the shul in honor of that participatory role, usually in a multiple of $18, or Chai, the Jewish numerical symbol for life. Please enter your donation amount:*Click arrow at right to select$18$36$54$72$118$180$254$360$540$720$1,080Total $0.00 Donor InformationDonor Name* First Last Email*A confirmation will be emailed to this address. Enter Email Confirm Email Phone*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Payment InformationPayment Method* I will send a check to the CBI office Credit Card (Visa or MasterCard) Credit Card* MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Comments (optional)