In Kind Donation Form - Vita Centre printable pdf download

In Kind Donation Form - Vita Centre

101-75

Watline Avenue

Mississauga, ON L4Z 3E5

Phone:

905-502-7933

Fax:

905-502-7868

In-Kind Donation Form

Donor/Organization Name: __________________ _________________________

First

Last

Address: ___________________________________________________________

City: _______________________________, ON

Postal Code: _______________

Primary Contact: _____________________ Email: ________________________

Name

Telephone: (______)___________________ Fax: (_____)____________________

Amount: $________________ Cash: _____ Cheque: _____ Money Order: _____

Details of Donation: __________________________________________________

__________________________________________________________________

Donor/Organization Name as you would like it to appear when being recognized:

_____________________________________________

□

I would like to remain anonymous

□

I would like a tax receipt

□

Please add me to your newsletter

□

Please send me more information, am interested in volunteering with Vita

Centre

Vita Centre (legally know as Vita Manor) is a registered charity:

Charitable Registration # 89198 1235 RR0001 (Please note that charitable tax receipts will only be issued upon

request following Canada Revenue Agency rules.)

____________________________________________________________________________

For office use only:

Date received:

_______________________

Date of deposit/transaction: _____________________

Date entered in Income Manager: _____________

Thank you sent: _____________

Receipt # issued: ______________

Date Revised: June 2013

In Kind Donation Form - Vita Centre