Donation - St. Joseph's Lifecare Foundation

Donation Form

Donation Information

Wherever the Need is Greatest

Hospice

Long Term Care

Donation Type:

One-time gift

Monthly gift

Monthly Giving

Join the Monthly Giving Program for as little as $15 per month. Your monthly donation will be processed on the 15th of the month. Please choose the month you wish your donation to start.

An official tax receipt will be issued annually for your monthly giving contributions.

Starting the month of:

Group Donation:

Yes

Gift Amount:

$50

$100

$250

$500

$1,000

Other: (please specify)

Tribute Information

Is this a tribute?

Yes

Memorial Donation

In Honour gift Recipient

In memory of: In honor of:

Families often appreciate knowing that donations have been made in their loved one’s memory. Would you like to send an acknowledgement card to a family member? Would you like to send an acknowledgment card, notifying them of your donation?

Yes

Send Acknowledgement to: Send card to:

Name*:

Address*:

City*:

Province*:

Postal Code*:

Country*:

Is this donation on behalf of a company?

Yes

Contact Information

*First Name:

*Last Name:

*Email:

*Phone Number:

*Address:

*City:

*Province:

*Postal Code:

*Country:

Payment Information

We currently accept VISA and Mastercard.

Payment Via:

*Name on Card:

*Credit Card Number:

*Expiry Date:

*CBD/CVV:

In the interest of the environment and as a cost saving measure, St. Joseph’s Lifecare Foundation prefers to communicate with our donors electronically. If you do not wish to receive updates and donor information via email, please check the following box: