Memorial Wall - TheChaiCenter.com

Ordering Your Plaque for the Memorial Wall
You may use this form to order a Memorial Plaque for a loved one.
The plaque will be custom engraved and placed on The Chai Center's Memorial Wall, where it will be be illuminated during the week of the yahrtzeit.
Price per plaque is $440 payable either at one time or with four post dated checks $110 each. Checks should be made to The Chai Center.
Please allow two to four weeks for engraving.
My Name*
First NameLast Name
E-mail*
Phone*
Area CodePhone Number
Name of loved one being memorialized*
First NameLast Name
Relationship*
Plaque should read as follows: Please limit to 3 lines
Line 1:*
Line 2:
Line 3:
Payment Options*
Pay $440 in fullPay in 4 installments of $110

Payment

Credit Card Check

Postal / Zip Code

Country

Thank you for your payment. 100% of the proceeds of this donation or payment benefit The Chai Center, Inc.
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