Dixon Hall

One Time Donation Information

Thank you for your generous support!

Please provide your contact and payment information so that we can issue you a tax receipt.
An electronic tax receipt will be sent to the email address you enter below.

* Denotes required information

I would like to make a one time personal donation
I would like to make a one time donation on behalf of an organization

* First Name:
* Last Name:

Contact Information


	Home Work

Enter address manually
* Company Name:
* Address:

* City/Town:
* Country:
* * * Province/State:
* Postal/Zip Code:
Phone Number:	( ) Ext.
Cell Phone Number:	( )
* Email Address:
* Confirm Email Address:

I give Dixon Hall Neighbourhood Services permission to contact me by email
I give Dixon Hall Neighbourhood Services permission to contact me by mail (post)

Donation Designation

I would like my donation to go to the following:

I would like my donation to be in honour of:

I would like my donation to be in memory of:

Payment Information

* * Donation Amount:

* Processing Date:

installments

* Credit Card Type:

* Credit Card Number:

* Cardholder's Name:

* Credit Card Expiration:

Security Check

We have implemented an extra step in order to prevent Credit Card fraud. Unfortunately, some people use automated programs to test whether fraudulently obtained credit cards are valid. To counteract this practice we ask that you answer the question below.