To make a donation, please complete this form and
Mail it to our office:

Sixteenth Street Synagogue
421 Hudson Street
New York, NY 10014

Or Fax to: 212-206-3678
Or Call 212-255-4826 during office hours
9:00AM-2:00PM Mon - Thur
9:00AM-1:00PM Friday

Please provide the following:
About You: Name_______________________________________
Address_______________________________________________

City/State/Zip_________________________________________
Country______________________________________________
Email________________________________________________

About Your Donation
__General Donation………………………..………….......................... $_______
__Kiddush ($100)………………………………….............................. $_______
__Membership (Single $450, Family $800)…………................. $_______
__Building Fund………………………………………...........................$_______
__Yizkor, __ Yahrzeit……………...…………………….........................$_______
__Dedications (Ask for available dedications)………..................$_______
__Rabbi's Charity Fund………………….……………........................$_______

Form of Payment
__Check
__Credit Card
__MasterCard __ Visa __ American Express
Card Number__________________________
Expiration ____/____
Signature____________________________________________

The Sixteenth Street Synagogue and our community thanks you for your generosity.