Printed fromChabadWilliamsburg.org

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Community Mezuzah Project

Mezuzah order form

Mezuzah order form

Fill out the FREE kosher Mezuzah form below.
We will contact you to schedule a time to stop by and affix your new Mezuzah joining millions of Jews and over three thousand years of tradition.
Full Name*
First Name Last Name
E-mail*
Phone Number*
I am a*

Jewish community memberJewish Student at William & Mary
Year graduating
Note for Students: There is a $15 deposit We will ask when placing the Mezuzah.
This deposit will be refunded when you return the Mezuzah at the end of the year.

Address for Mezuzah*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

I would like*

A FREE Kosher Mezuzah on my front door.To purchase several more (beyond the first free one)
How many Mezuzah $60 each
Contribute to this project* Enabling others to have a Kosher Mezuzah

Yes, count me in!Not at the moment
Amount

$60 - Paying it forward$100 - Friend$180 - Supporter$500 - Pillar$1800 - Project sponsor

Payment

Credit Card Paypal

Postal / Zip Code

Country

Total

$60.00
I would like to receive news and updates by email
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