Marriage Services

Date Name Date

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 *

Nikkah/Marriage Services *

Price: $300.00

Off-site Fee

Price: $100.00

Pay with Debit/Credit Card *

Total

$0.00