BN: 108160250RR0001 Thank you for choosing to make a gift
Transcription
BN: 108160250RR0001 Thank you for choosing to make a gift
Thank you for choosing to make a gift through the Government of Canada Workplace Campaign in memoriam of your loved one In Memory Of (please print) Who would you like an acknowledgement sent to? We will send a card on your behalf to the person listed below to acknowledge your gift. Name: _______________________________________________________________________________ Address:______________________________________________________________________________ City: ____________________________________________ Postal Code: ________________________ Relationship to the deceased:_____________________________________________________________ Who is this donation from? If applicable, who should the tax receipt be made out to? Name: _______________________________________________________________________________ Address: _____________________________________________________________________________ City: ____________________________________________ Postal Code: _________________________ Payment Information ( ) Cash ( ) Cheque ( ) VISA ( ) MasterCard Amount of donation: ___________________________________________________________________ Card Number: ________________________________________________________________________ Name on Card: ________________________________________________________________________ Expiry Date: ___________________________________________________________________________ Telephone: ___________________________________________________________________________ United Way Ottawa 363 Coventry Road Ottawa ON K1K 2C5 BN: 108160250RR0001 Merci de faire un don par la Campagne de charité en milieu de travail du gouvernement du Canada en mémoire d’un être cher En mémoire de (lettres moulées SVP) À qui voulez-vous envoyer l’attestation? Nous enverrons une carte en votre nom à la personne ci-dessous pour attester de votre don. Nom: _______________________________________________________________________________ Adresse:______________________________________________________________________________ Ville: ____________________________________________ Code postal: ________________________ Relation avec le défunt:_____________________________________________________________ De qui provient ce don? si applicable, à qui le reçu aux fins de l’impôt doit-il être adressé? Nom: _______________________________________________________________________________ Adresse: _____________________________________________________________________________ Ville: ____________________________________________ Code postal: _________________________ Renseignements pour le paiement ( ) Comptant ( ) Chèque ( ) VISA ( ) MasterCard Montant du don: ___________________________________________________________________ Numéro de la carte: ________________________________________________________________________ Nom sur la carte: ________________________________________________________________________ Date d’expiration: ___________________________________________________________________________ Téléphone: ___________________________________________________________________________ Centraide Ottawa 363 chemin Coventry Ottawa ON K1K 2C5 BN: 108160250RR0001