Chultza Tnua Order Form
Each chultza costs $25.

Please fill out one for per chultza you will be ordering. If you would like to make a bigger order, please email mazkir@habonimdror.org. Contact mazkir@habonimdror.org with any questions.

Full Name *
Your answer
Affiliation with Habonim Dror North America *
Your answer
Email address *
Your answer
Is this chultza a gift? *
If yes, please put the recipient's name and mailing address below.
Your answer
Size *
They run a little small, so we advise that you order up a size. If you are unsure please ask.
Phone number we can best reach you at *
Your answer
How would you like us to get your chultza to you? *
Address *
If this chultza is a gift, please put your BILLING address below. Otherwise, please put your SHIPPING and BILLING addresses below.
Your answer
If you would like to arrange pick up plans, please explain:
i.e. who will pick it up at the office and when, which seminar, etc.
Your answer
Would you also like to make a donation to HDNA with your purchase? If so, please mark amount below.
Form of payment *
The cost per chultza is 15 dollars plus shipping.
Submit
Never submit passwords through Google Forms.
This form was created inside of Habonim Dror North America.