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23-24 CHALLAH ORDER FORM

Challah is delivered to your child's cubbie every Friday, with the exception of school closures, holidays and vacations. (9/29-5/31)

***ORDER DEADLINE: 9/22/23 - NO REFUNDS***

* Sliced challah Qty:

* Unsliced challah Qty:

* Child's First and Last Name (separate multiple children with a comma)

IF YOU HAVE MORE THAN ONE CHILD, PLACE ALL ORDERS WITHIN ONE TRANSACTION! JUST PUT THE INFO OF THE CHILD YOU WOULD LIKE THE DELIVERY TO GO TO BELOW (IF YOU ARE ORDERING MORE THAN ONE CHALLAH, YOU CAN SEPARATE THE CHILDREN WITH A COMMA AND WE WILL DELIVER ONE TO EACH).

* Child's Room Number (NS=Nursery School/BES=Briskin)

NS Room 1

NS Room 2

NS Room 3

NS Room 4

NS Room 5

NS Room 6

NS Room 7

NS Room 8

NS Room 9

NS Room 10

BES KA

BES KB

BES 1

BES 2A

BES 2B

BES 3A

BES 3B

BES 4A

BES 4B

BES 5A

BES 5B

BES 6A

BES 6B

Account Details

E-mail

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First Name

Last Name

Payment Information

Account

Online Fee:

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Card Type

Card Number

Expiration Date

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Confirm Account Number

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Merchant of Record: Temple Israel of Hollywood

Please contact Temple Israel of Hollywood 323 876-8330 if you have any questions or comments about the PAYQUIQ service or about payments.

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