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First Name
*
Last Name
*
Country
*
United States
Argentina
Australia
Austria
Bahamas
Belarus
Belgium
Brazil
Bulgaria
Canada
Chile
China
Cyprus
Finland
France
Germany
Greece
Hong Kong
Hungary
India
Israel
Italy
Jamaica
Japan
Mexico
Morocco
Netherlands
Poland
Portugal
Puerto Rico
Singapore
South Africa
Spain
Thailand
Tunisia
Turkey
Ukraine
United Kingdom
Venezuela
Virgin Islands, British
Virgin Islands, U.S.
City
*
Cell Phone Number
*
Email
*
Campaign Info
What is the total goal amount for this campaign?
*
When would you like to start the campaign?
When do you want your campaign to start
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2023
2024
2025
2026
Activity Time
*
Hour
Hour
1
2
3
4
5
6
7
8
9
10
11
12
:
Minute
Minute
00
30
am
pm
Which features would you like to use for your campaign?
*
Matchers
Automatic Tax Receipts
Pre filled forms/customized links
Recurring Donations
Teams
Donor App Platform
Do you have an existing Chabad Suite Account?
*
Yes
No
Which Payment Processor do you currently have?
Authorize.net
Stripe
Neither
Discount Code
10% off!
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