Jewish Records Indexing - Poland

Contribution Form

For security reasons, JRI-Poland does not accept
credit card contributions over the Internet.
Please fax, mail or telephone your contributions to:

Jewish Records Indexing – Poland
c/o Sheila Salo,  Treasurer
5607 Greenleaf Rd.
Cheverly, MD 20785

Telephone:  301-341-1261
Fax: 1-810-592-1768 (24 hours)

For Mail or Fax contributions, please complete all sections of this form.

Visa [ ]  MasterCard [ ]

Name as it appears on Credit Card _________________________________

Signature ______________________________________

Credit Card Number________________________________

Expiration Date_________________________
(NOTE: This form is for VISA and MasterCard credit cards only.)

Contribution in US$_______________
Please indicate the specific JRI-Poland project to which your
contribution should be directed.  Otherwise enter "general indexing" 

If your employer has a matching gift program, 
please think about matching your JRI - Poland donation through that program.
___________________________________________

Click here for Canadian Dollar Contribution Form

Billing Address of Credit Card

Street and House Number______________________________

Apartment or Flat Number_____________________________

City_________________________________________________

State/Province_______________________________________

Zip/Postal Code______________________________________

Country______________________________________________

Email Address________________________________________



Home Address (if different from Billing Address above)

Street and House Number______________________________

Apartment or Flat Number_____________________________

City_________________________________________________

State/Province_______________________________________

Zip/Postal Code______________________________________

Country______________________________________________

Home Phone___________________________________________



Jewish Records Indexing – Poland, Inc. is a non-profit 501(c)(3) organization.
Contributions to Jewish Records Indexing – Poland are tax-deductible in the
U.S. and Canada to the extent permitted by law.