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PICKUP FORM

First Name
Last Name
Email Address 
Home Address  

Please write the date and time that you would like your Pushka picked up:

Please pick up my Tzedaka box from my home
Please pick up my Tzedaka box from my doorman 
Please call/text me before you come. My number is:

You will receive a brand new tzedakah box upon pickup of your full one.
Thank you!