Pledge Form

Last Name		First Name
Address
City
Home Phone Number		E-Mail Address

I Wish to contribute to Congregation Beth Shalom

In Honor of:		on their:
In Memory of:

I would like my contribution to be designated to the following fund:

Amount Pledged

$ 18
$ 36
$ 100
$ 200
Other $

Method of Payment

Payment by Check - send check with copy of this form to CBS, 772 W 5th Ave, Naperville, IL 60564
Send me a bill
Payment by Charge Card - Call (630) 961-1818 with charge information

Pledge Form

I Wish to contribute to Congregation Beth Shalom

I would like my contribution to be designated to the following fund:

Amount Pledged

Thank you for your support of Congregation Beth Shalom