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Application for Zakat / Sadaqa Form
Masjid As-Salam ,Albany, NY, 12206, USA
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* Indicates required question
Date
*
MM
/
DD
/
YYYY
Full Name
*
Your answer
Driving Licence Number
*
Your answer
Application for Sadaqa or Zakat
*
Sadaqa
Zakat
Both
Email
*
Your answer
Home Phone
*
Your answer
Cell Phone
*
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Requested Amount
*
Your answer
Reason for Request
*
Your answer
Number of Dependents in Family
*
Your answer
Current Employment Status
*
Your answer
List Other Organizations you have requested help from
Your answer
Masjid you frequent the most
*
Your answer
Reference
Your answer
Do you CashApp / Zelle / Venmo / Bank Account
*
CashApp
Zelle
Venmo
Please send me Bank Check
I testify in front of Allah that all information i provided is true
*
Accept
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Internal Question Applicant dont respond- Application Status
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Internal Question Applicant dont respond - PAMT
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