Click here
for more info about making a donation
Donation Form
Thank you for giving.
You may make your donation online, by mail, fax, phone or in person.
Learn more on
How to Make Your Donation
.
Use the Tab key to move to the next field.
Donor Information
(For Receipting Purposes)
Title:
Mr.
Mrs.
Ms.
First Name:
*
Last Name:
*
Address:
*
City:
*
Province:
*
Postal Code:
*
Phone:
*
E-Mail:
Donation Amount
:
*
STEP 1
(
Required
)
Please direct my donation to:
Greatest Priority
Specific Event
-Select An Event-
Dreams Do Come True
Radiothon
Other Need or Area
STEP 2
(Optional)
This Donation is made: (Check one)
In Memory of
Name
In Celebration of
Honoree Name
Occasion
-Select An Occasion-
Birth
Birthday
Anniversary
Graduation
Wedding
Christmas
Other
STEP 2A
Would you like us to advise someone of this donation?
Yes
**
No
If YES, please complete the following information and we will send a card from you.
Name:
**
Address:
**
City:
**
Province:
**
Postal Code:
**
Lasting Contributions
I / We have made a provision for a bequest in our will.
I /We would like to become a monthly donor. Please contact me.
Payment Method
Cheque *
Credit Card Number
Expiry Date
mm/yy
Cardholders Name
Signature
__________________________________________________
If mailing or faxing this form.
How to Make Your Donation
ONLINE
1.
Complete the information above
2.
Click
BY MAIL
(for credit card or cheque donations)
1.
Complete the information above
2.
Click
3.
Mail to:
Cornwall Community Hospital Foundation
840 McConnell Avenue
Cornwall, Ontario
K6H 5S5
BY FAX
(for credit card donations)
1.
Complete the information above
2.
Click
3.
Fax to 613 930-4509
BY PHONE
Call the Foundation office at 613-930-4508.
To give in person, or if you have any questions, just
Contact Us
.
THANK YOU FOR GIVING!
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Donations
main page.
