Printed fromChabadMidtown.com

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Shabbat Reservation Form

Shabbat Meal Reservation Form
Please note: To reserve on Friday after 12:00 pm you must call the office 212-972-0770
*indicates required field
Full Name:*
First NameLast Name
E-mail:*
Phone Number:
Area CodePhone Number
Company Name:
Referred by:

Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Which Shabbat are you reserving for:*
MonthDayYear
Please note that our pricing has been revised.
How many persons Shabbat Dinner*
$65 per person
How many persons Shabbat Lunch*
$60 per person
I would like to make an additional donation to help sponsor Shabbat meals at Chabad (optional):
$90$180$450$1000$1800
I would like to sponsor in honor/memory of:
Total amount:
$0.00

Payment:*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Comments:
ANY CANCELLATIONS SUBMITTED AFTER THURSDAY 12:00 P.M. (EASTERN TIME) WILL NOT BE REFUNDED.
Should be Empty:

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