I would like to purchase  
 1 Ticket $100  
 2 Tickets $180  
 3 Tickets $250  
 7 Tickets $500  
 15 Tickets $1000  
 30 Tickets $1800

Sold / Referred by (if you are purchasing tickets due to an individuals recommendation please enter their name)        
Personal Info  

First Name

Last Name

Address

City

State

Zip / Postal Code

Phone

 
 

Email Address
Payment Info   

Name on Card

Card Type

Card Number

Exp. Date

  

CVV Code

  I will send a check to Chabad Chayil, 2601 NE 211 Terrace, Miami, FL 33180
 
 

A Joint Campaign Supporting Chabad Chayil & Various Chabad Institutions  

*No Purchase or Contribution Necessary to Enter or Win. Void where prohibited and restricted by law. Ends: 11:59:00 P.M. Eastern Time on 7/10/13.  See Official Rules for details on eligibility requirements, donation and entry options click here for OFFICIAL RULES.