YMCA Peer to Peer Fundraising

Thank you for supporting The YMCA of Greater Vancouver

Please provide your contact and payment information below. Your contact information is required to generate an electronic tax receipt which will be sent to the email address that you provide.

* denotes required information

Make a personal donation:
Make your donation on behalf of an organization:

Title:
* First Name:
* Last Name:

* Organization:

Contact Information


	Home Work

Enter address manually
* Address:

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

Allow the YMCA to contact me.

Permission for name to show on Fundraising Page which is viewed by public. Display Name
Permission for donation amount to show on Fundraising Page which is viewed by public.

Additional Information

Notes:

Payment Information

Note: If you select to give a monthly donation, "Donation Amount" refers to the amount you will give each month.

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:
* * Donation Amount:	$25.00 $50.00 $100.00 $250.00 $500.00 $1,000.00 Other
* Processing Date:
* Number of Installments:
	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:
Card Valid From
Issue Number

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