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Hanukkah Goodies Order Form

* First Name

* Last Name

* Phone Number

* Email

* How many are attending?

* Names of those attending

* Reserve Your Goody Box!

Hanukkah Goodie Box

$5.00

*E-mail

*First Name

*Last Name

Account

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Increase the payment amount by 3% to cover credit card fees (No fee for Checking)

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