Square One Older Adult Centre

DONOR INFORMATION

 

NAME                                                                                                          

 

ADDRESS                                                                                                                                     

 

POSTAL CODE                                               PHONE #   (        )                             

 

EMAIL   ________________________________________

 

CATEGORIES OF DONORS FOR SQUARE ONE OLDER ADULT CENTRE DONOR BOARD:

             BRONZE           - Donate $100 - $999

             SILVER               - Donate $1,000 - $4,999

             GOLD                - Donate $5,000 - $9,999

 

Larger Donations would be welcomed and prominently recognized.  Please contact the Executive Director for further information.  Donations between $25.00 - $99.00 are welcomed and receipted but are not acknowledged on our Donor Board.

                                      

AMOUNT DONATED    $                                          (CHEQUE ONLY)

 

All donations must be made in the form of a cheque.  Please make the cheque payable to “Older Adult Centres’ Association of Ontario”.  A tax receipt will be mailed to you.

 

Mail Donation to:          Square One Older Adult Centre

                                       100 City Centre Drive

                                       P.O. Box 2214

                                       Mississauga ON   L5B 2C9      

 

DONOR’S NAME TO APPEAR ON PLAQUE      ___________________

TAX RECEIPT TO BE MADE OUT TO:                SAME AS ABOVE 

 

NAME                                                                                                           

 

ADDRESS                                                                                                   

 

POSTAL CODE                                  PHONE #  (        )                                       

 

EMAIL _________________________________________

            

THANK YOU FOR YOUR GENEROUS SUPPORT!!

 

For Office Use Only

 

DONATION RECEIVED BY   _________________ DATE RECEIVED ________________

donation form