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Girls' Town Or Chadash
1417 Coney Island Avenue • Brooklyn, NY 11230
Personal Information
Full Name
*
Address
Zip code
*
Phone Number
Email Address
*
Transaction Details
$
Amount
*
Dedication
In memory of
In honor of
For the Yahrtzeit of
For the speedy recovery of
For the Birthday of
Dedication Name
Notes
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Girls' Town Or Chadash
1417 Coney Island Avenue
Brooklyn, NY 11230
Tell: 7182581212
[response]
ID #[transid]
[created]
[cardholder]
$ [amount]
[cardtype] [ccnum4]
Authorization Number
[authcode]
AVS Response
[avsresult]
CVV response
[cvcresult]
[otherTransaction]
