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Contact (Donor) Information Name: Address: City: Country: Province/State: Email: Postal/Zip Code: Home Phone: (Receipt will be sent at year-end to the above address) Donation Amount I wish to make a contribution in the amount of $ (Canadian dollars): Select Amount 10 20 30 40 50 Or fill in your own: Type of Donation (please choose one): General Donation Donation in memory of: Donation in honour of: Donation directed to: Please select how you would like the donation directed Timothy Eaton Memorial Church General Fund Congregational Fund Church Capital Fund Mission and Service Fund Radio Broadcast Fund Send an acknowledgement card to: Name: Address: City: Province/State: Country: Postal/Zip Code: Signed by: Additional Comments (Optional): Other comments you would like to have included on the acknowledgment card: Credit Card Information Card Type: Select Visa Name: (as appears on card): Card Number: Expiration Date: Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Please enter the image code below Security code We thank you for your generosity.Charitable Registration No. 108110180RR0001
We thank you for your generosity.Charitable Registration No. 108110180RR0001