PAYQUIQ ONLINE :: The Faster Smarter Way to Pay

Memorial Plaque order form

* Please enter the English name of the person you want to remember

Please enter the Hebrew name of the person, including son/daughter of ...

for example "Mosheh ben David and Sarah", or "Sarah bat Arye Leib and Rivkah"

* Please provide the date of death

Please indicate if the death occurred before or after sunset, as this affects the Hebrew date.

Please indicate how you want the Hebrew date of death to appear on the plaque

Any additional notes/instructions

Memorial Plaque

$270.00

I prefer to mail in a check

We recommend that you use the secure payment form below, but if you prefer to mail in a check, please select this option.

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

The fees are significantly lower for Electronic Checks. Please consider paying with an Electronic Check. If you are paying by credit card, please select YES to increase the amount by 3% to cover credit card fees.

Total: