Memorial Plaque Order Form:

Part 1: Information of the person whose memory you wish to honor
(The information in this part is used to make the plaque; please complete exactly the way you would like it to appear)

Last name

First name English Jewish/Hebrew

Date of birth Day Month Year

Date of passing Day Month Year

Time of passing AM PM

Optional
Jewish date of passing Day Month Year Check converter


Father's first name English Jewish/Hebrew

Mother's first name English Jewish/Hebrew

Part 2: Relative information
(Information of the relative requesting plaque)

First name

Last name

Address Postal code

City State

Email

Relationship to the person that passed away

Part 3: Yahrtzeit notification

If there are any other additional relatives to be notified before Yartzeit, please list name and address info. Thank you.

1. First & last name

Address Postal code

City State Country

Email

2. First & last name

Address Postal code

City State Country

Email

3. First & last name

Address Postal code

City State Country

Email

Part 4: Payment information

Our policy is Open door/No Membership; no one will be turned away due to lack of funds, we hope you will contribute to the extent of your ability, and help Chabad of Oxnard with its work.

The 'Tzedakah'-Charity act in memory of a loved one, helps the soul rest in peace and achieve a higher place in the world up there.

Suggested contribution for a Memorial Plaque is $360 or more.
A receipt for income tax purposes will be issued.

I prefer another method of payment
Please specify:

 

Online Credit Card Payment:

Amount $360 Other

If needed:
Please charge this amount to my Credit Card in instalments of $ each month.

Card Type

Card Number

Expiration date

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