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BETH SHALOM CONGREGATION - PAYMENT OPTION FORM 25/26

Please submit this form by email or mail no later than July 14, 2025 if you are starting automatic payments in July. Otherwise, please return this no later than July 31, 2025

I/We agree to pay Beth Shalom Congregation my (our) Annual Membership Costs and Religious School tuition (if applicable).  Periodic Payments are accepted but MUST be processed through an automatic checking account withdrawal (ACH – no fee) or credit card payment initiated by Beth Shalom.  (A 3% convenience fee will be applied for credit/debit card payments to cover the associated costs.)  

The periodic amount will be auto-calculated. Example: Membership Cost of $3,100 divided by 9 monthly payments equals a periodic payment of $344.44 for 9 months. (This does not include the 3% cost added if paid by Credit/Debit Card.)

I. TOTAL PAYMENT AMOUNT 

This is the total amount from your invoice including Dues, Building Fund and Religious School tuition (if applicable), but does not include the 3 % convenience fee for credit/debit card

II. MONTHLY PAYMENT OPTIONS 

Beth Shalom automatically collects annual membership and tuition costs around the 15th of each month.

For 12 payment installations, this form must be submitted by this form by July 14, 2025.

Alternatively, you may delay payment until August or September.  However, if your form is received after July 14, 2025, the most monthly payments you can make will be 11.

Submissions received after August 10 will begin on Sept. 15.

Note: the final payment will be completed no later than June 2026.