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Memorial Wall

Neshama (Soul) - Memorial Lamp Plaque Form & Prayer Book & Chumash Dedication Form
I wish to share with you that we are now able to offer you the opportunity of marking the passing of your loved one that will eternalize their memory in our new Neshama (soul)- Yahrtzeit Memorial Wall. Each plaque will have the Hebrew and English name and date of yahrtzeit and a lamp that will be lit each year for the yahrtzeit.
Dedication Opportunities

Memorial Wall Plaque $500 Prayer Book $36 Chumash $70 Memorial Wall Sponsor $5400 - a special large dedication plaque will be placed in memory of your loved one or in your honor, also includes Two regular plaque Column Sponsor $2400 - a special dedication plaque will be placed in memory of your loved one or in your honor, also includes one regular plaque
In Memory of
Full Name*

First Name Last Name
Hebrew Name

First Name Last Name
Fathers Name

First Name Last Name
Yartzeit Civil Date*
Jewish Date - leave blank if not known
Relationship to Deceased*
Total*

$36 $70 $500 $2400 $5400
Total

$0.00

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Other Information
Should be Empty:

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