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

Pay using Credit Card
Card Security Number is not supported in data entry. To process a credit card payment, you need to disable Card Security from the Electronic Payment page in the Configuration tab.
Payment Method:	One Time Payment Credit Card
* * Donation Amount:
* Processing Date:
	installments
Pay using PayPal
* Credit Card Type:
* Credit Card Number:
* Card Security Number:	Where is my Card Security Number?
* Cardholder's Name:
* Credit Card Expiration:



* Bank Name:
* Bank ID:
* Cheque Number:
* Transit number:
* Account Number: