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Oneg Shabbat Box Order Form

Place your order by Sunday, May 30.
Select your pick-up time below

* Your Name:

* Phone Number:

* Your Congregation:

	Congregation Beth Chaim
	Other

If Other, please enter name:

Pick Up Time

	Thurs, June 3, 6-8pm
	Fri, June 4, 10am-12pm
	Fri, June 4, 12-2pm
	Fri, June 4 at Shabbat Services

* Recipient:

	Self
	Other

If Other, please enter recipient name and contact information:

* Number of Oneg Shabbat Boxes

SUPPLIES ARE LIMITED.

Brought to you by Beth Chaim's Membership Committee.

PAYMENT OPTIONS
Payments can be made via checking account (no online fee) or by credit card (additional online fee). Be sure to make the selection under the "Payment Information" section below.

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Total:

Oneg Shabbat Box Order Form

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

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