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Instructions for filling out Marriage Form
Fill out the information for the Groom, the Bride, and the Wali
Select whether you want the appointment at the masjid or outside of the masjid
Pay the amount to submit your application
Groom (The Husband) Information
Groom: First Name
*
Groom: Middle Name
Groom: Last Name
*
Groom: Date of Birth
*
Groom: Phone Number
*
Groom: Address
*
Groom: Mother Full Name
*
Print the full name of the groom’s mother
Groom: Father Full Name
*
Print the full name of the groom’s father
Groom: Place of Birth
*
Where the groom was born
Groom: Conditions of the Marriage
Write out any conditions from the husband
Bride (The Wife) Information
Bride: First Name
*
Bride: Middle Name
Bride: Last Name
*
Bride: Date of Birth
*
Bride: Phone Number
Bride: Address
*
Bride: Mother Full Name
*
Print the full name of the bride’s mother
Bride: Father Full Name
*
Print the full name of the bride’s father
Bride: Place of Birth
*
Where the bride was born
Bride: Conditions of the Marriage
Write out any conditions from the wife
Bride: Religion
*
The deen/religion of the bride.
Name of Wali / Wakeel
*
The full name of the wali or wakeel (of the bride)
Number of Wali / Wakeel
*
The phone number of the wali or wakeel.
Relationship of Wali / Wakeel
*
The relationship of the Wali/Wakeel to the bride (ex. Father or Uncle, etc.)
Amount of Dowry – (Mahr Agreed upon)
Mahr Muqaddam (Advanced)
*
The immediate mahr
Mahr Muakhar (Deferred)
*
The deferred mahr
Email
*
Email you would like to be reached back from
Date / Time
*
Date
Time
Enter in the preferred date & time. If the Imam is booked at that hour, we will correspond via email to find a suitable time for everyone.
Location of Marriage Ceremony
*
— Select Choice —
At Imam’s Office
Outside of Masjid (off-site)
Wali Layout of
Nikkah/Marriage Services
*
Price:
$300.00
Off-site Fee
Price:
$200.00
Pay with Debit/Credit Card
*
Credit Card field is disabled, Stripe keys are missing.
Total
$0.00
Submit