Siddur Pirchei Kodesh Dedication Order Form

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Siddur Pirchei Kodesh Dedication Order Form

A book plate with your dedication will be affixed to a siddur at Holy Blossom Temple

Contact Information

First Name

Last Name

Email

Are you a member at Holy Blossom Temple?

YesNo

How many prayer books do you wish to dedicate?

Dedication #1

Please provide the text for the dedication below

i.e. This prayer book is dedicated in honour/in memory/in appreciation/in gratitude of

Dedication #2

Please provide the text for the dedication below

i.e. This prayer book is dedicated in honour/in memory/in appreciation/in gratitude of

Dedication #3

Please provide the text for the dedication below

i.e. This prayer book is dedicated in honour/in memory/in appreciation/in gratitude of

Dedication #4

Please provide the text for the dedication below

i.e. This prayer book is dedicated in honour/in memory/in appreciation/in gratitude of

Dedication #5

Please provide the text for the dedication below

i.e. This prayer book is dedicated in honour/in memory/in appreciation/in gratitude of

Credit Card Information

Total Cost

$

CDN

First Name

Last Name

Billing Address

City

Province/State

Please Specify

Postal Code

Credit Card Number

Visa or Mastercard

Expiry Month

Expiry Year

Hidden Fields

Invoice Name

Authnet_Hidden_Fields

Contact Information