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Yahrtzeit Memorial Plaque Order Form

 

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Sample Memorial Plaque Information: 
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Below is a sample of the information required for each name submitted:
Name : Walter Cohen  Hebrew Name: Moshe Father's Hebrew Name: Avrohom
Date of Passing: September 1, 1989    Hebrew Date of Passing (if Known): 13 of Elul 5759
Calculate the Hebrew date of passing here

 

Part 1:
DEDICATION PLAQUE (Information of the person(s) whose memory you wish to honor)
I/we would like to dedicate  plaque/s.

This information will used to make the plaque; please complete exactly the way you would like it to appear.
PLAQUE #1   PLAQUE #2
Name   Name
Hebrew Name   Hebrew Name
Father's Hebrew Name   Father's Hebrew Name
Date of Passing
mm/dd/yyyy
  Date of Passing
mm/dd/yyyy
Hebrew Date of Passing (if known)   Hebrew Date of Passing (if known)
 
Part 2:
RELATIVE INFORMATION (individual requesting plaque)
First name    Last name
Address   City
State   Zip
Phone   Email
 
Part 3:
PAYMENT DETAILS
The suggested contribution for a Memorial Plaque is $500 or more. A receipt for income tax purposes will be issued.
Name on card   Amount to be charged
Card Number   Card Type
Exp. Month       Exp. Year
Billing Zip      CVV Code    4 digits on the front of Amex.
3 digits on back of Visa and MasterCard.
 

Alternatively you may print this form and mail it with a check to:
Chabad at Porter Ranch - 19043 Rinaldi Street, Porter Ranch, CA 91326

Our policy is, and always will be, Open door/No Membership; no one will be turned away due to lack of funds. We hope you will continue to contribute to the extent of your ability, and help Chabad at Porter Ranch continue with its vital work. The 'Tzedakah' - Charity act in memory of a loved one, helps the soul rest in peace and achieve a higher place in the worlds above.