Canadian Mental Health Association, Ontario
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Donation Form

Please fill out the following information so that you can contribute securely online. In the event we are unable to process your donation, we request an e-mail address and phone number to contact you to make corrections. Thank you for your generosity!

DONOR INFORMATION
 
E-Mail:
Title (Mr., Mrs., Ms, etc.):
Name:
Corporate Name (optional):
Address:
City:
Province:
Country:
Postal Code:
Phone Number:
Your e-mail is required to receive a confirmation of your donation.
 
 
CREDIT CARD INFORMATION
 
Credit Card:
Credit Card Number:
Name on Card:
Expiry Date:
Donation Amount:
 
TRIBUTE GIFTS (In Memoriam and In Honour)
 
Making a donation in the name of a friend or family member is a lasting and meaningful way to let others know you care about the issues of mental health. You may wish to make a donation in memory of a loved one, or in honour of someone on a special occasion or as a note of thanks for a helpful act or a kind word.
 
A Gift Notification card will be sent to the person or family to acknowledge your thoughtful gift. Your charitable tax receipt, accompanied by a letter of thanks, will be mailed to you shortly afterwards.
 
Type of Gift:
Name of person this donation is in honour/memory of:
 
Please send a Gift Notification card to:
 
Name:
Address:
City:
Province:
Country:
Postal Code:
 
How would you like to sign the card? (e.g., "The Smith Family")
 
Special message on card (maximum 35 words):
NOTE: The amount of your gift will not be mentioned.
 
PLEASE SEND ME INFORMATION ABOUT...
 
Comments / additional information (maximum 50 words):
 
   * Please click Submit button only once

Note: When making your donation securely online it is very important to hit the Submit button once only and wait for the authorization receipt to come up on the screen. If you hit the Submit button twice or hit Stop and re-submit, you run the risk of having your credit card authorized twice for your one donation. The system works quickly, and you will have a credit card authorization receipt on your screen within 10 to 60 seconds, depending on bandwidth. If any problem occurs, please e-mail us immediately.

To ensure the security of your personal information you have been taken to a secure form on a secure server hosted by our payment provider - Paypaq™ Solutions Inc. Paypaq™ Solutions Inc. is a Level One Service Provider, compliant under Payment Card Industry Data Security Standards (PCI) (www.paypaq.com). Look for the locked lock on your browser's status bar or https: to ensure you are submitting your payment information on a secure form.


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