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Printable
Form
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To support the work of the Canadian Landmine Foundation you can count on me for a tax-deductible gift of: $10 $20 $40 Other $ ___________ |
Name: _______________________________________________________________________ Street Address: ________________________________________________________________ City: _________________________________________________________________ Province: ___________________________________ Postal Code: _______________________ Email address: ________________________________________________________________ In Memory of:: _______________________________________________________________ In Honour of:: _______________________________________________________________ Enclosed please find a cheque or bill to my VISA MASTERCARD AMEX Credit Card Number: ____________________________________________________________ Expiry Date: _______________________ Name (as it appears on card): _____________________________________________________ Signature: ________________________________________________
OPTION #1: I'd like to make a monthly gift
from my chequing account. I've enclosed a sample cheque marked "void",
to give you the information necessary to make the automatic withdrawals. OPTION #2: I prefer to make a monthly gift
through my |
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Charitable Number: 866765423 RR0001 |