KAHAL KADOSH BETH ELOHIM
90 HASELL STREET
CHARLESTON, SC 29401
843-723-1090

ORDER FORM FOR COMMEMORATIVE BRICKS

Name of Donor: _____________________________________________________
 
Address: ___________________________________________________________
 
City: ______________________________________________________________
 
State: _____________________________________________________________
 
Zip Code: __________________________________________________________
 
Telephone: _________________________________________________________
 
Number of bricks: __________________________________________________
 
Amount of enclosed: ________________________________________________
 
 
 
 
 
Name of Honoree (18 letters): ______________________________________
 
Address: ___________________________________________________________
 
City: ______________________________________________________________
 
State: _____________________________________________________________
 
Zip Code: __________________________________________________________
 
Occasion: __________________________________________________________
 
 
 
 
 
 
 
 
If you wish to send information for more than one brick, please make a
copy of this form.  We will notify the recipient of your gift. 
Thank you for your order.