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 Fill this form and mail to:


P.O.Box 2190, Kfar Saba 44425 Israel

□ I would like to contribute monthly __________

□ Please accept my one-time gift of ___________

My enclosed donation for “AHAVA LANIZKAK” is designated for the following purpose:

□ School material

□ Food and other products for babies

□ Food for needy families or individuals

□ Hygiene products

□ Other (specify): _______________________

□ Where most needed

Name: ____________________________________
Phone: ____________________________________
Address: __________________________________
City: ______________________ State: __________
Zip code: ___________ Country: ______________
E-mail: ____________________________________

I would like to receive ______ copies of your brochures to distribute among friends.

Bank Details:
Mizrahi Tefahot Bank 20
Swift Code: Mizbilit
Branch No. 424
132-134 Weizman St. Kfar Saba, Israel

Account No. 625116
IBAN :IL84 0204 2400 0000 0625 116