PERSONALIZATION FORM FOR KETUBAH

Return form to: 20th Century Illuminations PO Box 53 Athol, MA 01331
Or Fax to: 978-544-2247

Please print and fill in this form with no abbreviations. 
Information will appear on ketubah EXACTLY as it appears on this form. 
Customer assumes all responsibility for accuracy of written information. 
Any special requests should be included in writing on this form.


Your Name__________________________________________________Phone:___________________________

Email Address_______________________________

Return Shipping Address_____________________________________________________________________

____________________________________________________________________________________________

Ketubah Name:____________________________  Text style: __________________________________

				
                		  HEBREW                  	    	ENGLISH            

Bride’s Full Name  __________________________________      _________________________________
         
Father’s Name      __________________________________      _________________________________                                                                        

Mother’s Name      __________________________________      _________________________________                                                                           

Groom’s Full Name  __________________________________      _________________________________                                                                          

Father’s Name      __________________________________      _________________________________                                                                        

Mother’s Name      __________________________________      _________________________________                                                                           

Wedding Location   ________________________     __________ 
                          City,            	  	State                                                                _

Date of Wedding   _________________________      ___ Before Sundown       ___ After Sundown
                       Day/Month/Year                                                                              

For Orthodox and Conservative Texts: (circle appropriate)

        Bride:		First Marriage		Divorced	Widowed	Converted
                
        Bride’s Father is:   Deceased	  Ha Cohen  	Ha Levi		Israelite

        Groom’s Father is:   Deceased	  Ha Cohen  	Ha Levi		Israelite

	Bride’s Mother is deceased?	Yes	No	Groom’s Mother is deceased?  Yes    No 
	
Special Instructions: