Member Financial Commitment Form

* First Name

* Last Name

* Email

* Phone Number

* I want to support Temple Emanuel financially with a contribution that is:

* I wish to make a monthly member contribution of $

* Start my automatic payment on this day of the month

Please enter a number from 1-30.

* I wish to make an annual member contribution of $

* Please select a payment option.

* Payment Plan

* Choose a Day of the Month for Payment

Please enter a number from 1-30.

* Choose a Date for Payment

Direct payments in the form of cash, check, and charitable distribution are fee-free and will increase the impact of your contribution to Temple Emanuel. All direct payments may be mailed or submitted in-person to the Temple Emanuel office. Debit and credit card payments will include an opportunity to donate the cost of the card transaction fee.

* Form of Payment

* Debit/Credit Card

By completing this - I authorize Temple Emanuel to initiate entries to my credit card for Membership Commitment. Please provide the following information:

Cardholder name
Billing address
Card number
Expiration date (month and year)
CVC code

I authorize the collection of the 3% credit card fees.

* ACH Direct Debit

By completing this - I authorize Temple Emanuel to initiate debit entries to my checking/saving account for Membership Commitment. Please provide a voided check and the following information:
Account holder name:
Bank Name:
Bank Transit Routing Number (9 digits)
Bank Account (10 digits)

Institution of Origin

Notes (Optional)

Sat, July 12 2025 16 Tammuz 5785

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