Class of 2025 Hersh-Polin Eitz Chaim Fund

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Name(Required)

First Last

Phone(Required)

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UID(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Gift Amount(Required)

$1,800

$613

$540

$360

$180

$54

$36

$18

Other

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Would You Like to Cover the 3% Credit Card Fee?(Required)

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3% Fee(Required)

Price: $0.00

Total

Credit Card

American Express

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Supported Credit Cards: American Express, Discover, MasterCard, Visa

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Expiration Date Month Year

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