300 Pleasant Valley Way • West Orange, NJ 07052
Tel: 973-731-0160 • Fax: 973-731-1160
www.bnaishalom.net
PURIM ORDER FORM
Your Family ID number from the attached list (located to the left of your name):
Name:
Address:
City:
State:
Phone:
Zip:
Email Address:
To Send to Member Families *
1.
2.
3.
4.
Dollar Totals
Circle the ID number on the left of each family on the attached sheets.
Enter the total number of member families IDs circled.
Multiply the number entered in item #2 by $5.00, and enter the total
If item #3 is $125 dollars, or more, you will receive free automatic reciprocation.
If item #3 is not $125 or more, check here
for the Automatic Reciprocation Option
at $5.00 per basket (you will be billed later).
$__________
* Member families living outside the delivery area must make arrangements to pick up their baskets.
Our delivery area is West Orange, Livingston, Roseland, Montclair, Short Hills, Cedar Grove,
Belleville, Verona, The Caldwells, Maplewood, South Orange, and Essex Fells.
To Send to Non-Member Families **
5. Enter the names and addresses of the non-members that are to receive baskets on the
separate form provided. Please print clearly.
6. Enter the number of baskets to non-members that are in our delivery area or that you
would like to pick up at the synagogue.
** Our delivery area is West Orange, Livingston, Roseland, Montclair, Short Hills, Cedar Grove,
Belleville, Verona, The Caldwells, Maplewood, South Orange, and Essex Fells.
7.
8.
9.
10.
Multiply the number of baskets entered in item # 6 by $18, and enter the total.
Enter the number of baskets to member college students.
Multiply the number of baskets in item #8 by $18, and enter the total.
Enter the number of baskets to non-members outside of our delivery area that we will ship
to anywhere in the United States.
11. Multiply the number of baskets in item #10 by $25, and enter the total.
$__________
$__________
$__________
Add the dollar totals from lines 3, 7, 9 and 11.
$__________
Enclose a check made out to ‘B’nai Shalom’ for this amount.
Check here if you would like to pick up any basket sent to you.
Baskets may be picked up after the Megillah reading on Wednesday, March 4.
Check here if you will not be home on Purim and cannot receive delivery.
Check here if you would like to participate but don’t want a basket sent to your home.
YES! I WANT TO VOLUNTEER….
To help deliver baskets
Name: ______________________
To help package the baskets
Office Use Only
CK/AMT ______/________
BA E/R ________/________
DEIC __________________
300 Pleasant Valley Way • West Orange, NJ 07052
Tel: 973-731-0160 • Fax: 973-731-1160
www.bnaishalom.net
NON-MEMBER PURIM ORDER FORM
Your Family ID number from the attached list (located to the left of your name):
1.
Name: __________________________________________________________
Address: _________________________________________________________
City: ______________________________
Check one:
2.
Local Delivery
State: _________ Zip:________
Shipment
College Student
Name: __________________________________________________________
Address: _________________________________________________________
City: ______________________________
Check one:
3.
Local Delivery
State: _________ Zip:________
Shipment
College Student
Name: __________________________________________________________
Address: _________________________________________________________
City: ______________________________
Check one:
4.
Local Delivery
State: _________ Zip:________
Shipment
College Student
Name: __________________________________________________________
Address: _________________________________________________________
City: ______________________________
Check one:
5.
Local Delivery
State: _________ Zip:________
Shipment
College Student
Name: __________________________________________________________
Address: _________________________________________________________
City: ______________________________
Check one:
6.
Local Delivery
State: _________ Zip:________
Shipment
College Student
Name: __________________________________________________________
Address: _________________________________________________________
City: ______________________________
Check one:
7.
Local Delivery
State: _________ Zip:________
Shipment
College Student
Name: ___________________________________________________________
Address: _________________________________________________________
City: ______________________________
Check one:
Local Delivery
State: _________ Zip:________
Shipment
College Student
Your Name:
Your Number (from the list below):
CIRCLE the numbers or names that you wish to send to
1
Clifford & Karen Aaron
38
Nat & Gloria Brot
75
Leonard & Nancy Fisher
2
Barbara Alsieux
39
Steven Brot
76
Brian & Barbara Flumen
3
Saul Andron & Susan Tober
40
David Brown & Rhea Coblentz
77
Ilan & Rochelle Forster
4
Stanley L. & Cecille Asekoff
41
Seth & Heather Brown
78
Florence Frankel
5
Edith Bamdas
42
Gerry Buchoff & Geri Weinberg
Buchoff
79
Bruce & Susan Friedman
6
Jonathan & Hannah Bargad
43
Michael Burakoff
80
Joseph & Betty Friedman
7
Benjamin & Nicole Bartfeld
44
Stephen & Donna Burkat
81
Mark & Carol Friedman
8
Don & Lisa Batchelder
45
Wayne & Jill Canastra
82
Murray Fryd
9
Kenneth & Jackie Becker
46
Andrew Caplan & Vicki Phon Caplan
83
Jordan & Susan Galatz
10
Benjamin Beilin
47
Rena Casser
84
Bruce Gallant
11
Mel & Helyn Benjamin
48
Robert Cherry
85
Marc & Eylana Garfinkle
12
Arie & Elaine Ben Shalom
49
Jody Chinitz
86
Helen Geffner
13
Blanka Berger
50
David & Sharon Cimbol
87
Larry & Donna Gelber
14
Donald & Eileen Bergman
51
Arnold & Rosalind Citrin
88
Giancarlo Genovesse
15
Miriam Bergwerk
52
Bruce Cohen
89
David & Leslie Gleaner
16
Robert & Janet Berger
53
Howard & Randi Cohen
90
Floyd & Sharon Goldsman
17
Irving & Frieda Berkowitz
54
Jerry & Ellen Cohen
91
Marc & Ellen Goldman
18
Stephen & Donna Berowitz
55
Seth & Marisa Cohen
92
Paul Goldman
19
Gary & Adinah Bialik
56
Sonia Cohenson
93
Richard & Robin Goldberg
20
Edward & Trudy Bier
57
Michael & Ewa Cohen
94
Ronald & Maria Goldberg
21
David & Anne Blady
58
Charles & Faith Cohn
95
Jerry & Carol Golub
22
Rob & Hella Blazer
59
Sharon Cohn
96
Bea Goodman
23
Dennis & Janet Block
60
Janice Colmar-Michaelis
97
Jonathan & Bonnie Goodman
24
Gary Blumsohn & Saralee Rosen
61
Steven & Robin Colten
98
Arthur & Bobbie Gordon
25
Lawrence Blumberg
62
Howard & Roberta Coopersmith
99
Eric & Sharon Gordon
26
Marvin & Susan Blum
63
Clara Creditor
100 Eric & Tammy Greenberg
27
Richard & Ellen Bodner
64
Leona Crystal
101 Larry Greenwald & Vicki Alvy
28
Lloyd & Evelyn Borak
65
Jacki Dakss
102 Michael Greenwald
29
Lester & Marilyn Bornstein
66
Jerome & Brenda Deener
103 Alan & Ellen Grossman
30
David & Barbara Bortniker
67
Steven & Wendi Dumbroff
104 Harvey & Debra Grossman
31
Selma Breitman
68
Jamie & Jennifer Dunst
105 Marcia Grossman
32
Henry Bressman
69
Ian & Bonnie Ebner
106
33
Roy W. Breslow
70
Stuart & Hannah Edelman
107 Stephen & Jenny Gruhin
34
Michael & Barbara Brien
71
James & Gail Ellowitch
108 Alan & Susan Hammer
35
Marilyn Brien
72
Dave Esrig & Rachel Plafker - Esrig
109 Larry & Suzie Hammer
36
Michelle Brittner
73
Miky & Renee Faibis
110 Rudolf & Lotte Hammer
37
Adam Brodsky & Mathi Fuchs
74
Kenneth & Lori Falkenstein
111 Jeffrey & Debra Handsman
Robert Grossman & Susan
Tarnofsky
Your Name:
Your Number (from the list below):
CIRCLE the numbers or names that you wish to send to
112 Toby Handsman
149
Myra Kurland
186 Mark & Joy Milwicki
113 Michael & Gail Herman
150
Paul & Nancy Kurland
187 Abe & Sonny Minde
114 Andrew & Susan Hirsch
151
Charles & Judy Kurtzer
188 Zemer & Sharon Mizrahi
115 Laurence & Janet Hoffer
152
Herbert & Selma Kushner
189
116 Adam & Rachel Horwitz
153
Leonard & Michele Leff
190 Alexander & Larisa Mushkin
117 Arthur & Ronnie Horn
154
Donald & Ellen Legow
191 Tommy & Lisa Nadler
118 Phil & Tania Horn
155
Barbara Leinwand
192 Robert & Roberta Nahum
119 Barry & Elise Horowitz
156
Robert & Debbie Lesser
193 Edward & Barbara Newman
120 Steven S. & Bonnie Isaacson
157
Samuel & Arlene Levine
194 Gavin & Elise Norwitz
121 Gloria Jackson
122 Stanley Schwartz & Marion
Jacobson
123 Steven & Goldie Jacoby
158
Stewart & Gail Levine
195 Bill & Jo Nossen
159
Barry & Sindy Liben
196 Barry & Angela Okoskin
160
Aaron Liebman & Leora Heckelman
197 David & Shirley Oltchick
124 Marc & Leslie Kallus
161
Clara Liebenthal
198 Ted & Anne Oshman
125 Ari & Laura Kampel
162
Gail Liebmann
199 Marilyn Osofsky
126 Samuel & Susan Kamens
163
Glenn & Erica Lieberman
200 Barry & Bobbi Ostrowsky
127 Shirley Kantor
164
Yvette Lieberman
201 Gilda Paul
128 Barbara A. Kaplan
165
Gary & Rhonda Lillianthal
202 Herbert & Bernice Peitzer
129 Henry & Tina Kaplan
166
Uzi & Connie Lior
203 Cory & Amelia Perlstein
130 Michael & Jane Kaplan
167
Jeff & Paula Lipkin
204 Thomas & Renee Phon
131 Esther Kaplan
168
Ted & Shelly Lipka
205 David & Gloria Plotkin
132 Hillel & Arlene Karp
169
Elayne Lite
206 Leonard & Gail Pogach
133 Howard & Orit W. Kastner
170
Bruce & Ann Logan
207 Irwin & Kathryn Pollack
134 Jules & Edythe Katcher
171
Bruce & Barbra London
208 Philip & Shirley Pomerantz
135 Lawrence & Audrey Katz
172
Barry Lovett & Tova Rothschild
209 Alan & Hilda Pressman
136 Irving & Hope Kerzner
173
Brian & Marlene Lynn
210 Larry & Tami Prince
137 Michael & Bonnie Kessler
174
Jeffrey & Sharon Maas
211 Herbert & Elayne Punia
138 Michael Kesselbrenner
175
Robert & Mary Mandel
212 Jeffrey & Noreen Punia
139 Jeff & Sherry Kirschenbaum
176
Stewart & Rhoda Manheim
213 Tami Rager
140 Ivan & Bobbie Klein
177
Jerry Marcus & Fran Orzech
214 Rose Raposa
141 Adele Kleiman
178
Arthur & Ruth Maron
142 Howard & Roberta Knauer
179
Lori Mayer
215 Norman & Marsha Raymond
Bernard Reger & Debra
216
Manheim Reger
Michael Monson & Fani MagnusMonson
143 Arnold Koster & Lenore Rabin-Koster 180
Jeffrey & Sheryl Mazur
217 Norman & Valerie Riback
144 Adam & Ruth Kraemer
181
Martin & Janet Mellinger
218 Elaine Richmond
145 Daniel Kram
182
Noel Meltzer & Milinda Carson
219 Evan Riff & Heidi Valese
146 Kenneth Kraus & Francesca Peckman
183
Morton & Roselyn Milden
220 Harry & Nancy Riff
147 Howard Krieger
184
Sharon Miller
221 Russell & Marci Robinson
148 Beverly Kronen
185
Ezriel & Eleanor Milun
222 Larry & Laura Rolnik
Your Name:
Your Number (from the list below):
CIRCLE the numbers or names that you wish to send to
223
Gloria Rosenberg
260
Gary & Nancy Silver
224
Harriet Rosenstein
261
Jack Silverman & Rochelle Doliner 298 Flora Musleah Yavelberg
225
Michael & Marcl Rosenstark
262
William & Joyce Silverman
299 Roberta Yecies
226
Solomon & Jeannette Rosenstark
263
Mark Simon
300 Neal & Leba Yolin
227
Alfred & Candace Rosu
264
Alla Skalrud
301 Robert & Sharon Yontef
228
Herbert & Muriel Rozansky
265
Alvin & Rosanne Skopp
302 Marty & Abbie Young
229
Joel & Lauren Rublin
266
Bonnie Smiler
303 Joel & Sharon Zucker
230
Abby Ruder
267
Joanne Snyder
231
Seth Saltzman & Debbie Simet
268
Eli & Teri Solomon
232
Larry Sass & Tracey Miller
269
Fredric Solomon & Randee
Rappoport Solomon
233
John & Sarah Schapiro
270
Richard & Phyllis Some
234
Michael & Helaine Scharfstein
271
Seymour Some
320 Abby Ruder
235
Nat Schlossberg
272
Max & Myrna Spinrad
321 Deborah Robinson
236
Cookie Schneiderman
273
Al & Anne Spring
322 Veronica Wisseh-Weah
237
Bart & Harriet Schneiderman
274
Ivan & Debbie Stein
323 Oren Mars
238
Gary & Jill Schneiderman
275
Muriel Stendig
239
Jesse & Stacey Schneider
276
Sydelle Stern
240
Michael & Barbara Schneider
277
Fred & Anita Strauss
241
Morton & Leah Schneider
278
Ronni Strell
242
Charles & Adele Schuman
279
Robert & Beth Stricof
325 Rena Casser
243
Dean & Li Schuman
280
Ronnie & Carol Strulowitz
326 Dee Dorit Elie
244
Lois Schuback
281
Ruth Tabenkin
327 Michelle Nadel
245
Stuart Schub
282
Kenneth & Leah Tarlow
246
Bennett & Debra Schwartz
283
Kate Tarnofsky
247
Louis & Laura Schwartz
284
Harvey & Jill Tekel
248
Martin & Carol Schwartz
285
May Tessler
249
Terry & Amy Schwarz
286
Hayden & Gayle Tiger
330 Leslie Gleaner
250
Walter & Inna Shafir
287
Wayne & Maureen Tillman
331 Jeff Kirschenbaum (USY)
251
Stanley K. Shapiro & Ann Hirsch
Shapiro
288
Robert & Lisa Tobin
332 Margo Heda (TRA)
252
Simone & Lynn Shenassa
289
Phyllis Tolkowsky
333 David Lipsitz (HH Leader)
253
Jack & Mirabella Sheppard
290
Misha Tsirulik & Leah Shulman
334 Aaron Liebman
254
Jay & Geri Sher
291
Ben & Yael Webber
335 Gordon Rayfield
255
Fedor & Rosa Shmulevich
292
Hanna Wechsler
256
Michael & Diane Shoobs
293
Les & Arlene Weinstock
257
David & Rena Siegel
294
Mark Weinberg
258
Jasmine Siegel
295
Dennis & Andrea Wertheimer
259
Morris & Ruth Silver
296
Ron Wise
.
297 David & Joan Wynn
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Religious School
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