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KADDISH & YAHRTZEIT SERVICES
FAX OR MAIL FORM
* Blanks marked with an asterisk are required KADDISH IS BEING ORDERED BY: Your name*: ________________________ Contact phone: ______________________ | KADDISH IS TO BE SAID FOR: Full name: _______________________ Full Hebrew name*:_________________ Father's name: ____________________ Fathers Hebrew name*:______________ Date of death (mm/dd/yy)*: __________ Hebrew date of death: _______________ Approximate time* __________________ Relationship to you: _________________ | | SEND CONFIRMATION LETTER AND YAHRTZEIT REMINDERS TO: Name: _____________________________ Address: ___________________________ City / State: ________________________ Zip: _______________________________ | | KADDISH PLAN REQUESTED*: ◊ Daily $360 ◊
◊ Single Yahrtziet $36 ◊
| | I WISH TO PAY WITH*: Visa ◊ Master Card◊ American Express◊ Fill out card information box and mail or fax this form to 877.656.3759 Check or money order◊ Mail in this form with check payable to: Rabbi Dan Hayman 2110 E Lincoln Dr, Phoenix AZ 85016 | CARD INFORMATION: Name of Card*: ____________________ Billing Address*: ___________________ Address 2: ________________________ City / State*: _____________________ Zip*: ____________________________ Card Number*:____________________ Expiration (mm/yy)*:_______________ |
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Имеются Еврейские календари на новый еврейский год. Если вы желаете получить календарь бесплатно, то 
