Contribution Form for non-Internet donations

If you prefer not to make your credit card contribution over the Internet or would like to pay via personal check, please use this form.

Please fax, or telephone, or mail (with check) 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)

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

Please complete ALL sections of this form.

Visa [ ]  MasterCard [ ]  (Visa or MasterCard only, please)

Name as it appears on Credit Card _________________________________

Signature ______________________________________

Credit Card Number________________________________

Expiration Date_________________________

Contribution in US$_______________

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

___________________________________________

Billing Address of Credit Card

Street and House Number______________________________

Apartment or Flat Number_____________________________

City_________________________________________________

State/Province_______________________________________

Zip/Postal Code______________________________________

Country______________________________________________

Email Address________________________________________

Home Phone___________________________________________ 


Home Address (if different from Billing Address above)

Street and House Number______________________________

Apartment or Flat Number_____________________________

City_________________________________________________

State/Province_______________________________________

Zip/Postal Code______________________________________

Country______________________________________________

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. to the extent permitted by law.