Prayer Request Sign Up

Step 1 - Sign-Up for the 40 Days

Your details are strictly confidential and will never be revealed without your prior consent.
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First name of person being prayed for:
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Last name of person being prayed for:
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Does s/he have a Hebrew name?:
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What is his/her mother's name?:
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Does she have a Hebrew name?:
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What is your prayer request?:
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If the prayer is for having children, provide the Hebrew Name of the Father-to-be:
Details about the person prayed for:
Donation amount:
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Tax-Deductible
 ($90) Standard Prayer
($360) Exclusive Prayer
($720) Personalized Exclusive Prayer
($540) 40 Days at the Holy AriZal's tomb
($540) 40 Days at King David's tomb
($1800) Premier Prayer
($3600) Choice Prayer
Description of Prayers
Total Donation:
Tax-Deductible
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$
Please start my Prayers Rosh Chodesh Elul, August 10th
Immediately
Tell us what best describes you:
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Form of payment for your donation:
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Credit Card (Secure Service). *Prayers generally start within a week.

Check will be mailed. *Prayers generally start approx 3 weeks from the date of mailing from the US or Canada (see address below).
Name on the Card:
Type of Credit Card:
Credit Card Number:
Expiration Date:  
CVV / CID on the back of the Card:
How did you find out about us?
Please check ALL that apply:
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 Aish
Saw You at Sinai
Frumster
Facebook  Myspace  Twitter
Web Search
Email Blast
Print Ad
Newspaper Article
Word of Mouth
Return Donor
Arutz Sheva
Other
When is your birthday?:
Would you like us to ask others to pray for you by including your prayer request in our newsletter?:
Terms and Conditions
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 Western Wall Prayers reserves the right to adjust and/or refuse certain prayers based on Rabbinic direction. In a case where prayers are refused, a full refund will be made.
I AGREE
 
Checks to be mailed in America Checks to be mailed in Israel
Should be made out to: Should be made out to:
American Friends of Kollel Tefillat Moshe Kollel Tefillat Moshe
and mailed to: and mailed to:
American Friends of Kollel Tefillat Moshe
116 South 4th Avenue Highland Park
NJ
08904-2623		 Kollel Tefillat Moshe
C/O Sima Loewenstien
7/10 Ohr Hachaim Street
Kiryat Sefer, Modiin Ilit 71919
Israel

When your form is submitted, you will receive a confirmation email. If you do not receive this confirmation, please contact info@westernwallprayers.org. Thank you!

 
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