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B'nei Mitzah Deposit Form

* Name of Bar/Bat Mitzvah

* Assigned Date of Bar/Bat Mitzvah

* Name Parent/Guardian 1

* Parent/Guardian 1 Phone Number

Please share the best number to contact this person with.

Name Parent/Guardian 2

Parent/Guardian 2 Phone Number

Please share the best number to contact this person with.

* Bar/Bat Mitzvah Deposit of $100.00

$100.00 deposit for each Bar/Bat Mitzvah child. If you would prefer to pay by check, please email Nina Pachino at [email protected] for a hard copy of this deposit form.

I understand that the $100 deposit and completion of this form reserves the above assigned Bar/Bat Mitzvah date for my child(ren). (Should you choose to continue the celebration at the temple following the service, please contact Althea Carrington at 443-278-9350 or [email protected] to hold the room.)

* Signature of Parent/Guardian

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

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