For office use only: P Aliza Boyer 236 Washington Avenue, #3 Brooklyn, NY 11205 646.812.0584 [email protected] www.ketubahgraphia.com Ketubah Graphia loc:_______ This form can either be filled out online and emailed back to me or please send in the mail to the address above. Please contact me by phone or email if you have questions. Date of Order Phone E-mail TEXT & DESIGN DETAILS (Please fill in all sections that apply): Type of Ketubah: Printed (16x23”) *Custom *If Custom, please specify size: 16x20” **Original 22x30” **If Original, please use description from website: Text Choice: Language(s): Both Hebrew & English Other(s) English only _______________________________________________ Ink Color(s): English Text Layout: Interlinear (alternating lines) English Font: Script Paper Orientation: Vertical Hebrew/Aramaic only Hebrew Other Stacked (Eng over Heb or vice versa) Block Horizontal Papercut Design: Additional decorative papercut poetic phrase (add $150.00): Personalization (Your names, date/place of ceremony included into body of the ketubah text) Yes * No *If yes, please fill out Page 2 of this form in full. Additional handmade gifts for Family, Friends and/or Wedding Guests: # of Home Blessings (add $100/ea) # of Grand/Parent Blessings (add $150/ea) ADDITIONAL NOTES OR INFORMATION: O ___/___/___ CUSTOM ORDER FORM and PERSONALIZATION DETAILS Customer Name(s) C PERSONALIZATION DETAILS Date of wedding: Day of week: Hebrew date (if known, or I can look it up): Before Sundown After Sundown City and State of ceremony: Coupleʼs Information (Note: Please fill out all names exactly as you would like them to appear on the ketubah) Person 1: English Name Person 1: Hebrew Name (Note: If no Hebrew name(s), please write ʻTransliterateʼ) Person 1: Parentʼs English Names Mother Father Person 1: Parentʼs Hebrew Names (Note: If no Hebrew name(s), please write ʻTransliterateʼ) Mother Are parents living? Is Father: Kohen Father Father: Yes No Levi Mother: Yes No Israelite Person 2: English Name (as youʼd like it to appear on the ketubah) Person 2: Hebrew Name (Note: If no Hebrew name(s), please write ʻTransliterateʼ) Person 2: Parentsʼ English Names Mother Father Person 2: Parentsʼ Hebrew Names (Note: If no Hebrew name(s), please write ʻTransliterateʼ) Mother Are parents living? Is Father: Kohen Father Father: Yes Levi No Mother: Yes No Israelite Signature Lines Number of additional witness signature lines (beyond standard two): Title for officiantʼs signature line: Rabbi Cantor Officiant Label signature lines (“Bride”, “Groom”, “Witness”, “Rabbi”, etc.): Other Yes No SHIPPING & PAYMENT Ketubahs are shipped using FedEx priority mail and the cost is included in the price. For expedited or international shipping, additional charges apply. Please contact me for details. Ketubahs can also be picked up at the Ketubah Graphia studio in Brooklyn, NY. Date ketubah needed by: Ship Pick up at Brooklyn, NY studio Ship to Name: Ship to Address: Apt./Unit# City/Country Home State/Province Office Other Zip specify: Phone Number: Special Shipping Instructions: Printed and Original ketubahs require full payment at time of order. Custom ketubahs require a 50% deposit at time of order and the balance due before ketubah ships. Method of payment: Check Cash Type of Credit Card: AMEX Visa Credit Card MasterCard Money Order Direct Deposit Discover Card # Exp: CVV: Zip code associated with credit card: Please donate a percentage of the sale of our ketubah to (check one): Human Rights Campaign Natʼl Art Education Association Foundation for Jewish Culture