Library Membership

Full Name*
First Name Last Name
E-mail*
Phone Number*
Please note the following points:
- Late Fees - $5 per week
- Damage - $20
- Lost - $30
I am a Chabad member*

YesNo
Member Price*

$18
Non-Member Price*

$36
Number of books I would like to purchase*
The amount of books I would like to purchase*
Total

$0.00 CAD

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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