HHCH Donation Form

ONLINE DONATION FORM

Hope House offers specialized services and support to those diagnosed with life-threatening illness, family caregivers and those who are bereaved. Thanks to the generosity of our donors and sponsors Hope House continues to offer all programs at no cost.

Charitable Registration: 13451 7820 RR0001

Type of Donation*

general in memory of (enter memorial information below under "Tribute Information") in honor/ on behalf of (enter in honour of information below under "Tribute Information")

Other:

Donation Amount*

An official tax receipt will be sent to donor for donations $20 and over.

DONOR INFORMATION

Name*

First Name

Last Name

Email*

Phone*

Address (Line 1)*

Street Address

City*

Province*

Postal Code*

Country

PAYMENT INFORMATION

Help us cover costs*

Yes, I would like to cover the 3% processing fee so that 100% of my donation goes to support Hope House I would prefer Hope House cover processing fee

Donation amount (includes processing fee)

Donation amount

Cardholder's Name*

Credit Card*

TRIBUTE INFORMATION for memorial & honour of donations

First Name for memorial or honour donations

Last Name for memorial or honour donations

Acknowledgement Card (optional):

Mail an ACKNOWLEDGEMENT CARD on my behalf I don't want an acknowledgement card sent

Card to go to (name(s)):

Address:

City, Province, Postal Code

Card recepient's relationship to Honoree

Name(s) to appear on the "from" section of the acknowledgment card:

ie "Smith Family", "Susan & John Smith" or "Your colleagues at Acme Inc.",

Message for acknowledgement card &/or special instructions for Hope House