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			<h1 class="article-header__title js-article-title js-page-title">Tzedaka Box Order Form</h1>
		
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<form class="userform-form" action="" method="post" name="form_6427004" id="6427004" accept-charset="utf-8"><input type="hidden" name="formID" value="6427004" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li class="form-line" id="id_13"><div id="cid_13" class="form-input-wide"> <img alt="" class="form-image" border="0" src="https://w2.chabad.org/media/images/1382/izUj13823446.png" height="219.45000000000002" width="665" /> </div></li><li class="form-line" id="id_3"><div id="cid_3" class="form-input-wide"> <div id="text_3" class="form-html"><h2 style="text-align: center;"><span style="color:#3498db;"><em><strong>Chabad of the Crescenta Valley is excited to present our<br />
NEW Chabad Pushka!</strong></em></span><br />
 </h2>

<p>A Pushka is a small charity box that is kept in every Jewish home and office. Chabad is excited to present our own custom Pushkas that we are providing to every Jewish home and office in the Crescenta Valley area free of charge!<br />
 </p>

<h2 style="text-align: center;"><span style="color:#3498db;"><em><strong>"A little charity goes a long way: both for the giver, and the recipient..."</strong></em></span><br />
 </h2>

<p><em><strong>The Lubavitcher Rebbe of Blessed </strong></em><em><strong>Memory, </strong></em>the inspiration behind Chabad of the Crescenta Valley and the 5000 Chabad centers worldwide, would encourage everyone to have a charity box (pushka) in their homes and offices, and to make daily deposits to charity. The presence of a pushka is a constant reminder of the need to fulfill the mitzvah of charitable giving (tzedaka).</p>

<p>While the sum of a donation may be larger when it is given all at once, it does not increase within the donor the trait of generosity as when the donor gives habitually. The very act of daily giving, even just a few coins, converts generosity into an innate part of the person’s character.<br />
 </p>

<h2 style="text-align: center;"><span style="color:#3498db;"><em><strong>Please join in this beautiful initiative and fill out the form below to receive a free Tzedaka box delivered to your home or office. </strong></em></span><br />
<br />
<span style="color:#3498db;"><em><strong>May the merit of the Mitzvah of Tzedaka serve as a source of blessing for you and your entire family, bringing health, happiness, and success in all of your endeavors!</strong></em></span></h2>
</div> </div></li><li id="cid_5" class="form-input-wide"> <div class="form-header-group"><h2 id="header_5" class="form-header">Form</h2></div> </li><li class="form-line" id="id_6"><div class="form-label-left" id="label_6"><label for="input_6"> Full Name<span class="form-required">*</span> </label><label class="label-message" for="input_6"> </label></div><div id="cid_6" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q6_fullName[first]" id="first_6" autocomplete="given-name" />  <label class="form-sub-label" for="first_6" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q6_fullName[last]" id="last_6" autocomplete="family-name" />  <label class="form-sub-label" for="last_6" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_7"><div class="form-label-left" id="label_7"><label for="input_7"> E-mail<span class="form-required">*</span> </label><label class="label-message" for="input_7"> </label></div><div id="cid_7" class="form-input"> <input type="email" class=" form-textbox validate[required, Email]" id="input_7" name="q7_email" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_8"><div class="form-label-left form-label-hidden" id="label_8"></div><div id="cid_8" class="form-input"> <div class="form-single-column form-checkbox-item"><input name="optin" value="true" type="checkbox" checked="checked" class="form-checkbox" id="input_8" /><label id="label_input_8" for="input_8">I would like to receive news and updates by email</label></div> </div></li><li class="form-line" id="id_9"><div class="form-label-left" id="label_9"><label for="input_9"> Phone Number<span class="form-required">*</span> </label><label class="label-message" for="input_9"> </label></div><div id="cid_9" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input data-type="mask-number" class="mask-phone-number form-textbox validate[required]" type="tel" name="q9_phoneNumber[full]" id="input_9_full" autocomplete="tel" />  <label class="form-sub-label" for="input_9_full"><span> </span></label></span></div> </div></li><li class="form-line" id="id_12"><div id="cid_12" class="form-input-wide"> <div id="text_12" class="form-html"><p><em><strong>Please submit phone number to best reach you to arrange time / date for delivery.</strong></em></p>
</div> </div></li><li class="form-line" id="id_10"><div class="form-label-left" id="label_10"><label for="input_10"> Address For Delivery<span class="form-required">*</span> </label><label class="label-message" for="input_10"> </label></div><div id="cid_10" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-line" type="text" name="q10_address[addr_line1]" id="input_10_addr_line1" size="46" autocomplete="address-line1" />  <label class="form-sub-label" for="input_10_addr_line1" id="sublabel_10_addr_line1">Street Address</label></span></td></tr><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line no-validation" type="text" name="q10_address[addr_line2]" id="input_10_addr_line2" size="46" autocomplete="address-line2" />  <label class="form-sub-label" 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