Mikvah appointment request

Name*
Email*
Phone
Requested date and time
Appointment type

Shower - member $20Shower - non-member $50Bath - member $30Bath - non-member $60
Sliding scale available

Payment

Zelle: [email protected]

Venmo: chabadjupiter
Payment Amount

$20$30$50$60

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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