Mishloach Manot order form:

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Personal Details:

First Name:   Surname: 

Phone Number :  Address:   

Email: 

   

  Order:  (Choose a quantity you would like to order for anything over 10, please email CYadmin@Chabadyouth.org)

Small Mishloach Manot: 

Medium Mishloach Manot: 

Large Mishloach Manot:  

Purim Cards:  

 

  Payment:

Cash                         Cheque                             Credit Card  

                                   Mastercard             Visa

Name on Card:      Card Number: 

Month of Expiry:      Year of Expiry: 

 

-We wish you a happy Purim-