DONATION FORM - Canadian Mental Health Association, …

|DONATION FORM |
|I would like to make mental health matter by supporting CMHA, Ontario's |
|efforts to improve the lives of people with a mental illness. |
| |
|Donor Contact Information (For charitable tax receipt) |
| |
|Name: Miss/Mrs./Ms./Mr. __________________________________________________________________ |
| |
|Mailing Address: _________________________________________________________________________ |
| |
|City: ____________________________ Province: __________________ Postal Code: _______________ |
| |
|Telephone (H): ________________________ (B): ________________________ x. __________ |
| |
|E-mail: ______________________________________________ |
| |
| |
|I would like to donate: |
| |
|( $250 ( $100 ( $50 ( $25 ( $10 ( Other Amount: $ ____________________ |
| |
|Method of payment: |
| |
|( Money Order |
| |
|( Cheque (Please make payable to Canadian Mental Health Association, Ontario) |
| |
|( Credit Card ( VISA ( MasterCard ( American Express |
| |
|Credit card number: | | | | | | | | | | | | | | | | | Expiration Date: | | | | | |
| |
|Name as it appears on card: __________________________________ |
| |
|Cardholder’s signature: _____________________________________ |
|Please mail or fax this form to: |
|CMHA, Ontario |
|c/o Susan Macartney, Database Administrator |
|180 Dundas St W |
|Suite 2301 |
|Toronto, ON M5G 1Z8 |
| |
|Thank you for your generosity! |
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Tax receipts will be issued for donations of $10 or more unless otherwise requested.
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