Order Your Cards

Fill out the information below and Chai Lifeline will mail the cards out on your behalf.

I would like to order cards at $3.00 per card.
For large quantities, please contact the office at (212)-699-6655

Enter the information exactly how you want it displayed.
   
I would like to contribute the minimum suggested: $
I would like to contribute a total of: $
Your donation amount will be:      $
 
Customer Billing Information
Your billing address must be entered exactly
as it appears on your credit card statement.
Credit Card Payment Information:
First Name:
Last Name:
Company Name:
Address:
City:
State/Prov:
Zip Code:
Country:
Phone Number:
Email Address:
Card Type:
Card Number:
Expiration Month:
Expiration Year:
Verification Code:
This is the 3 or 4 digit number printed on the back signature panel. It is on the front of the card for American Express.
Comments:
  
Security Check
required fields
Please mail a receipt to the address above (in addition to the receipt I will receive via email).


Please wait a moment while we process your request.
Do not hit the "Process Order" button more than once!

Your IP Address: 54.242.205.33
This number can be traced back to you and is only recorded to prevent and prosecute fraud.


© 2017 Chai Lifeline
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