"*" indicates required fields Contact InformationName* First Last Email* Balance of Fees*Enter the amount that you will be paying off with the payment plan. Payment Plan*Here is where you set up your monthly payment plan. You have between 2-12 months to pay off your balance. Your first payment will be today. You will receive an email confirmation with the amount of each payment.Number of payments One Time OnlyRecurring Setting up paymentsInstallmentPayment Interval2 WeeksMonthNumber of Payments Credit Card InformationIf you prefer paying by check, mail to Bais Chana Women International, 383 Kingston Avenue, Suite 248, Brooklyn, NY 11213.Credit Card* American ExpressMasterCardVisaSupported Credit Cards: American Express, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Security Code Cardholder Name CAPTCHA Δ
