TRIBUTE CARD DONATION

Contact Information

Title

First Name

Last Name

Home Phone

Business Phone

Do you consent to receive electronic correspondence (i.e., event information, newsletter, et cetera) from JCFS?
Yes No

Address Information

Home

Business

Business Name

Issue Tax Receipt in Business Name

Address

City

Province/State

Postal/ Zip Code

Donation Information

General Agency Cards (minimum donation of $10.00)
Cover Our Kids With Care (minimum donation of $18.00)

Amount of contribution

Card Information

How would you like the card addressed? (For example- Dear Elaine and Howard; The Silver Family: Mr. and Mrs. Silver)

What would you like to say in your personal message? (in 25 words or less)

How would you like the card signed?

Recipient Information

Recipient's name

Address of Card Recipient

City

Province/State

Postal/ Zip Code

Credit Card Information

Credit Card

Card Number

Cardholder Name

Expiry Date

If you wish to keep your gift anonymous please check here
Note: Charitable Tax Receipts will be mailed from our office one time during a calendar year.