To make a donation to the clinic, please print this page, fill in the required information below, and return it to:
66 Gerrard Street East
2nd Floor
Toronto · Ontario · M5B 1G3
Yes, I would like to support Hassle Free Clinic by making:
| A single donation of: |
$25 |
$50 |
$100 |
$250 |
|
other: $___ |
| A monthly donation of: |
$5 |
$10 |
$20 |
$50 |
|
other: $___ |
| Date: ________________ |
| Name: ______________________________________ |
| Address: ____________________________________ |
| City: _________________ |
Province: ___________ |
| Postal code: ___________ |
Phone: _____________ |
| ___ |
I have enclosed one cheque payable to the Hassle Free Clinic |
| ___ |
I have enclosed __ post-dated cheques payable to the Hassle Free Clinic |
| ___ |
I prefer to charge my donation to my credit card: |
| |
Visa: |
____________________ |
Master Card: |
____________________ |
American Express: |
____________________ |
Expiry date: |
____________________ |
Name as it is on card: |
____________________ |
Signature: |
____________________ |
|
Your charitable tax credit receipt will be mailed to the name and address above. Charitable registration number 11895-4221.
