MRT special items

	MONMOUTH REFORM TEMPLE DONATION FORM

For your convenience, you may use this form to make donations to Monmouth Reform Temple.

I wish to make a donation of $

If your credit card authorization is already on file at Temple, you may submit this form on-line.

Please charge this amount to my credit card (authorization already at Temple) ($5.00 minimum)

Please charge this amount to my Temple credit balance
Otherwise, please print this form and fax it to 747-9770 or mail it to: Monmouth Reform Temple, 332 Hance Ave., Tinton Falls, NJ 07724.

Attached is my check for this amount

Please charge this amount to my credit card (authorization form completed below) ($5.00 minimum)

This donation is being made:
IN HONOR OF:
IN MEMORY OF:
OTHER OCCASION:

This donation is being made by:

NAME:

ADDRESS:

CITY/STATE/ZIP:

E-MAIL:

Please send an acknowledgement to the following:

NAME:

ADDRESS:

CITY/STATE/ZIP:

I have chosen the fund indicated below:
Adult Education Fund
Arts & Decorations Fund
Cantor's Music Fund
Fink Music Fund
Flower Fund
Fund for the Homeless
Fund for the Righteous
General Fund
Library Fund
Mazon Fund
Oneg Fund
Prayer Book Fund ($20 minimum)
Rabbi's Fund
Religious School Fund
Scholar-in-Residence Fund
Scholar-in-Residence Fund
Youth Group Fund

Please DO NOT list this donation
in the Temple Bulletin

If not already on file, please complete this written authorization if you wish this, and possibly future donations, to be charged to your VISA or MASTER CARD account.
(If you use this box, you must submit the form by fax or US Mail)
I authorize Monmouth Reform Temple to handle payment of __ only this donation, __this and future donations, by charging these amounts to my:
Master Card #_________________ or VISA #_________________ Expiration Date:______
Print Name:________________________

Signature:_______________________________________ Date:______________________

(These arrangements will remain in effect until receipt of written request for change.)

Thank you for your donation!

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