Book of Remembrance Yizkor Book Order Form

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Contact Information

Your Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Remembered by:*

Name(s) of Person(s) Remembering Dear Ones

In Memory of (Names):*

Please list all the names you would like listed. You may state “SAME AS LAST YEAR” (Phonetic spelling NOT REQUIRED).

If you have any questions about your Yizkor Book listing or would like to check your last year's listing, please call or contact the office at .

Donation Amount*

Minimum of $10.00 per line

Payment Information

Payment Method*

Indicate your method of payment by checking one of the options below:

Credit card

Check

JCSVV adds a 3% card processing fee to all credit card transactions in order to help defer the cost of the credit card processing fees.

Price: $0.00

Total

Credit Card

American Express

Discover

MasterCard

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Card Number

Expiration Date

Security Code Cardholder Name

Checks are to be made payable to JCSVV and mailed to: Jewish Community of Sedona and the Verde Valley, PO Box 13, Sedona, AZ 86339. Please indicate that donation is for the Yizkor Book.

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Book of Remembrance Yizkor Book Order Form

Contact Information

Payment Information

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