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The Mezuzah Campaign

Kindly fill out the form below to have a mezuzah checked, to order a new mezuzah, or to request help putting up a mezuzah.

Title 

First Name  

Last Name

Home Address 

City Province

Postal Code Country

Phone  
This is my Home Business  Cell

Email Address

Services:

I have a Mezuzah that I would like checked (no charge)  

Please help me put up a Mezuzah

 I would like to purchase  Mezuzah(s) at $35 each and  Cases at $2.50 each.  (We have available a limited number of complimentary white cases.)  Subsidies available - Please make note in comments section below.

Will pay at the door

Pay online now 

Credit Card Type   visa mc amex.jpg

Name as it appears on credit card 

Credit Card Number 

Expiry Date  

CVC Code 


Comments

 

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