"*" indicates required fields Contact InformationName* First Last Email* PhonePayment InformationPayment Amount*Enter the total amount that you will be paying then choose one time payment if you are paying it all today or recurring if you want to set up a payment plan. NotesPlease make a note of what this payment is related to.Payment Type*Here is where you set up your monthly payment plan. You have between 2-6 months to pay off your balance. Your first payment will be today. Number of payments One Time OnlyRecurring InstallmentInstallmentPayment IntervalMonthNumber of Payments Credit Card InformationIf you prefer paying by check, mail to Bais Chana Women International, 383 Kingston Avenue, Suite 248, Brooklyn, NY 11213.Total Credit Card* American ExpressMasterCardVisaSupported Credit Cards: American Express, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name CAPTCHA