Charitable Donation Form

Charitable Donation Form

Page 1

Campaign ID

Donation Amount

$25$75$100$250Other amount

Other Amount:

$

Donation Type

One-TimeRecurring

Campaign Name

Frequency

Your Information

Title

First Name

Middle Name

Last Name

Email Address

Phone Number

Additional Information

This donation is on behalf of a companyBy clicking here, your tax receipt will be made out to the company as entered below.

Company Information

Select From Existing CompaniesAdd New Company InformationPlease search for an existing company before adding new.

Select From Existing Companies

Company Name	Street Address
City Province State State	Country Postal Code

Payment

Donation Amount

$

Credit Card Information

Name on Card

Card Number

MM

YY

CVV Code

Billing Address

Billing Address is same as Company

Billing Street Address

City

Country

Province

State

State

Postal Code

Please do not publicly recognize my donations to ACFSelecting this will suppress recognition of your donations to the Alberta Cancer Foundation from our Donor Wall and annual Report to the Community

Would you like to dedicate this donation to anyone?

Yes, I would like to dedicate this donation.

By making a donation, you agree to receive occasional emails from us, including updates on how your support is making a difference. You can update your preferences here.

Page 2

Tribute Information

Type

First Name

Last Name

Mail on my behalf

Please notify a loved one of my gift

Mail on my behalf

Please send notification

Notification Method

First Name

Last Name

Address Lines

Address Lines

City

City

Country

Country

Province

Province

State

State

State/Region

Postal Code

Postal Code

Email

Email

Phone

Message