Jr WHECTY Bowling & Havdalah
CHILD'S INFO
Child's First Name
Child's Last Name
Child's Grade in School
5th Grade
6th Grade
7th Grade
Does your child have any food allergies?
Yes
No
Please explain
Member of Washington Hebrew?
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Yes
No
No, but I'd like to learn about WHC
Wonderful! We will be in touch very soon!
PARENT INFO
Parent First Name
Parent Last Name
Parent Cell Phone Number
Parent Email Address
How did you hear about this event?
2239, Young Professionals Group
Couples Club
Facebook
Friend
Instagram
RJW or E-T Early Childhood Center
WHC e-newsletter, "Life@Home"
WHC Journal
WHC Member
WHC website
Other
Please select all that apply
If "other" please explain
TOTAL COST
Subtotal
$
Admin Code (Staff Use Only)
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No
Yes
Enter Admin Code
Amount Due Today
$
Would you like to make a donation? Enter the amount below. Donations to the Lewis S. Wiener Annual Fund support the Temple's greatest financial need.
$
This donation is from:
Total Amount
$
Refund policy
PAYMENT METHOD
How would you like to pay your bill?
Credit Card (includes 3% fee)
ACH (Direct Bank Debit - No fee)
CREDIT CARD INFORMATION
To help defray some of WHC's credit card processing costs, a 3% fee has been added to your credit card payment. Please note that ACH payments do not include this fee.
Fee Amount
$
Grand Total
$
First Name on Card
Last Name on Card
Credit Card Number
Expiration Month
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01
02
03
04
05
06
07
08
09
10
11
12
Expiration Year
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2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
CVV
Billing Street
Billing City
Billing State
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Alabama
Alaska
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Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
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Hawaii
Idaho
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Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
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North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Billing Zip Code
ACH INFORMATION
Bank Routing Number
Bank Account Number
Bank Account Type
Checking
Savings
Bank Name
Account Holder's Name (
NOTE: If this is a joint account, use one name only. If it's a trust/foundation use one first/last name only
)
Billing Street
Billing City
Billing State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Billing Zip Code
Publicly Hidden Fields
Payment Section
Hide Payment Info
Hidden
Portal Pre-Fill Fields
Account ID
Contact ID
Outreach/Event Pre-Fill
OutreachID
DesignationID
Auth.net Connector Billing Info
Gateway Address
Gateway City
Gateway State
Gateway Zip
Gateway Totals
Gateway Quantity
Gateway Amount
Authnet_Hidden_Fields
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