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Title [Mr.Mrs.Ms.Dr.]

First Name

Last Name

Organization (for corp gifts)

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Phone (Day)

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Contribution Amount:

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Please type the cardholder name as it appears on the credit or Visa debit card.

For corporate donations requiring receipts under the corporate name please include the corporate name with the name of the cardholder.

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Please note that an official tax receipt will be issued under the cardholder's name. The Income Tax Act does not permit us to issue tax receipts to anyone other than the donor (the person whose name is on the credit card).

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