Memorial Plaque Order Form

Remember your loved one with a beautiful bronze memorial plaque that bears their name and date of passing. During the week of your loved one’s yahrzeit, we will display their plaque on the Memorial Wall in the Hertzberg Kaddish Lobby at the entrance to Kaufmann Sanctuary. On all other days, it will be enshrined in Gordon Archives Hall.

Each plaque is erected upon receipt of a donation of $2,000. You can make your full donation today or pay a $500 deposit per plaque. The balance is required to be paid within four years.

Questions? Contact Debbie Heller.

DONOR INFORMATION

First Name

Last Name

Email Address

Phone Number

Street Address

City

State

Zip Code

MEMORIAL PLAQUE PURCHASE

Will you make your full donation or pay a deposit?

Full donation ($2,000 per plaque)Deposit ($500 per plaque)

Name of Departed

Date of Passing

AMOUNT DUE

Total

PAYMENT METHOD

How would you like to pay your bill?

Credit CardACH (Direct Bank Debit)

CREDIT CARD INFORMATION

To help defray the cost of WHC's credit card processing, a 3% fee will be added to your to credit card payments. There is no fee for ACH payments.

Fee Amount

Grand Total

First Name on Card

Last Name on Card

Credit Card Number

Expiration Month

Expiration Year

CVV

Different billing address?

Billing Street

Billing City

Billing State

Billing Zip Code

ACH INFORMATION

Bank Account Type

CheckingSavings

Bank Name

Account Holder's Name

Bank Account Number

Bank Routing Number

Publicly Hidden Fields

Payment Section

Hide Payment Info

Hidden

Portal Pre-fill Fields

Account ID

Contact ID

Congregation Connect Fields

OutreachID

DesignationID

Auth.net Connector Billing Info

Auth.net Payment Info

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Memorial Plaque Order Form

Click SUBMIT only once to prevent your form from being processed multiple times.