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Member Financial Commitment Form
Please verify reCaptcha before submitting the form.
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First Name
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Last Name
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Email
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Phone Number
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I want to support Temple Emanuel financially with a contribution that is:
Choose One
Collected Automatically as a Recurring Monthly Payment
Billed Annually
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I wish to make a monthly member contribution of $
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Start my automatic payment on this day of the month
Please enter a number from 1-30.
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I wish to make an annual member contribution of $
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Please select a payment option.
Choose 1
Bill to my account and I will pay on a schedule that I create.
Bill to my account and start a payment plan .
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Payment Plan
Choose 1
Monthly
Quarterly
One-time Payment
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Choose a Day of the Month for Payment
Please enter a number from 1-30.
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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.
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Form of Payment
Choose One
Debit/Credit Card
ACH Direct Debit
Direct Payment
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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.
I authorize the collection of the 3% credit card fees.
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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)
Tue, July 1 2025 5 Tammuz 5785
