Full Name*First NameLast NameE-mail*# of plaques*$450 a plaque until Chanuka, $500 thererafterPlease Select1234Plaque #1Name of loved oneAs will appear on plaqueFirst NameLast NameHebrew name of loved one & their fathere.g Dina bat YaacovDay & Time of PassingTime of Passing can be approximateMonthDayYearat 123456789101112Hour001020304050MinutesAMPM Plaque #2Name of loved oneAs will appear on plaqueFirst NameLast NameHebrew name of loved one & their fathere.g Dina bat YaacovDay & Time of PassingTime of Passing can be approximateMonthDayYearat 123456789101112Hour001020304050MinutesAMPM Plaque #3Name of loved oneAs will appear on plaqueFirst NameLast NameHebrew name of loved one & their fathere.g Dina bat YaacovDay & Time of PassingTime of Passing can be approximateMonthDayYearat 123456789101112Hour001020304050MinutesAMPM Plaque #4Name of loved oneAs will appear on plaqueFirst NameLast NameHebrew name of loved one & their fathere.g Dina bat YaacovDay & Time of PassingTime of Passing can be approximateMonthDayYearat 123456789101112Hour001020304050MinutesAMPM Payment Options*Please SelectOne Time PaymentPay Over 3 MonthsPay Over 6 MonthsPay Over 12 MonthsPayment*Credit Card Check Credit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2019202020212022202320242025202620272028Expiration YearPlease send your check to Lubavitch of Yardley 1444 Yardley Newtown Road. Yardley, PA 19067 CHECK ACCEPTED FOR ONE TIME PAYMENT ONLY. TO PAY IN INSTALLMENTS A CREDIT CARD IS REQUIREDBilling AddressStreet AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNagorno-KarabakhNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandTurkish Republic of Northern CyprusNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTransnistria PridnestrovieTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryTotal$0.00I would like to receive news and updates by emailSubmitShould be Empty: This page uses TLS encryption to keep your data secure.
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