Mezuzah Rental Form

Only $5 delivery and installation included

Choose one option below for your Mezuzah rental

First and Last Name

Campus Address


Cell Number

Credit Card Number

Credit Card Expiration

Name on Card

Billing Address, City, State, Zip

Terms and Conditions

Mezuzah must be returned to Chabad on or before the date listed for the option you choose. If the Mezuzah is not returned by that date the rental will become a purchase, you will be charged the remaining balance of $31 and you will own the Mezuzah. The Mezuzah rental program is available only to students currently enrolled at the UW-Madison.

Please initial to indicate your acceptance of these terms