Kisseh Shel Eliyahu Application Personal Info Family Name: Father's Name: Mother's Name: Child's Birthday: Date/Time of Bris: Location of Bris: Name of Mohel: Home Address: City: State: Zip: Home Phone: Email: Contact Info on Day of Bris Name: Cell: Payment Info Name on Card: Billing Address: Card Number: Exp Date (M/YY): CVN: I understand that my card will charged by Olympia Relocation Inc. I would like to make a donation of $ to Lubavitch Chabad. I understand that if the chair is damaged or destroyed, I may be charged an additional amount on my card. I understand that if the bris is late, and the movers need to be on site for more than two hour, I may be charged for another hour. Digital Signature (type initials): Date of Application: This page uses 128 bit SSL encryption to keep your data secure.
