Lehigh Valley Kashrut Commission SUPERVISION REQUEST FORM

Date of Event*

MonthDayYear

Organization*

If Other, please specify:

CONTACT INFORMATION

Contact Person (First & Last Name)*

Name of Event*

Phone*

E-mail*

To whom should the Invoice be addressed to?*

Where should the Invoice be sent?*

EVENT INFORMATION

Location of Event*

Is the event a multi-day event? *

YESNO

If Yes, please fill out Multi-Day section below.

Time Mashgiach is Needed (please include prep time):*

:HourMinutesAM/PM Option

Time of Finish (please include clean-up)*

:HourMinutesAM/PM Option

Time Mashgiach is needed*

Approximate finish time*

Purchase Order Number (required for JCC registration, if you do not have a PO# - use 0)*

MEALS

If you are an outside Caterer, Please list your Business Name

Phone Number

Whom is preparing meals?*

Caterer Contact:

Business Address:

City

Zip Code:

Kosher Certification:

Who will be handling payment?

CatererOrganization or person hiring caterer

Please Describe Proposed Menu*

Additional Notes or Comments

Please Note: Any outside Caterer will need to make an appointment to meet with the LVKC prior to the event so that we can go over the LVKC rules and regulations, as well as go through the menu.

MULTI - DAY EVENT (Only fill out section if your a event is more than one day)

How many days is your event?

First Day of Event

MonthDayYear

Start Time:

Last Day of Event

MonthDayYear

Start

End Time:

Do you need a Mashgiach for different times , or everyday at the same time?

Same time each dayDifferent times each day

If different times are needed each day, please list each day here:

Date Day 1

MonthDayYear

Start

Finish Time

Date Day 2

MonthDayYear

Start

Finish Time

Date Day 3

MonthDayYear

Start

Finish Time

LVKC CORDINATOR

BILLING INFORMATION