General Information
Please print this form and fax or mail to:
FRIENDS of Canadian Broadcasting
200/238
131 Bloor Street West
Toronto, Ontario
M5S 1R8
Fax: (416) 968-7406
Please make cheques payable to FRIENDS of Canadian Broadcasting. If you prefer to donate by VISA or MasterCard, be sure to include your signature along with the amount of your contribution, your credit card number, and the expiry date.
You can also make your contribution online.
Printable Contribution Form
PART ONE
Name: ____________________________________________
Address: __________________________________________
___________________________________________________
Tel: ____________________ Fax: _____________________
E-mail: ____________________________________________
I am already a FRIENDS Supporter. SUPPORTER PIN ___________________________
PART TWO
Please check one.
I've enclosed my cheque payable to FRIENDS of Canadian Broadcasting
Please charge my: VISA MasterCard
Donation $__________________________________
Card # _____________________________________
Expiry Date _________________________________
Signature ___________________________________
Today's Date ________________________________
I prefer to make monthly donations and have completed PART THREE below
PART THREE
CHEQUING ACCOUNT AUTHORIZATION
I hereby authorize a chequing account deduction of
$5.00 $7.50 $10.00 $______
at
the end of each month. I understand that I may cancel this arrangement
in writing at any time. (Please mail this form and enclose a cheque
marked "void" so that we may make arrangements with your bank.)
Name: ___________________________
Signature: ________________________
or ...
CREDIT CARD AUTHORIZATION
I hereby authorize FRIENDS of Canadian Broadcasting to deduct:
$5.00 $7.50 $10.00 $______
from my credit card on the 15th of each month. I understand that I may cancel this arrangement in writing at any time.
Please charge my: VISA MasterCard
Card # ___________________________
Expiry Date _______________________
Signature _________________________
