HomeCanadian Wheelchair Foundation Online Donation Form
Online Donation

Please use this form to make an online donation. If there are specific details regarding your donation, please note them in the comment box at the bottom of this page.
Donor information
Campaign*
First name*
Last name*
Organization
Address*
City*
Country*
Province / State*
Postal Code / Zip*
Phone*
Email

* By providing your email address you grant us permission to email you and subscribe to our e-newsletter. You may revoke your subscription at any time by using the Safe Unsubscribe link found at the bottom of each e-newsletter.*
Anonymous donation
Donation Information

Amount (a minimum of $20.00 is required for Canadian tax receipt purposes)

Other Amount
(NO COMMAS OR PERIODS PLEASE) 		CAD $195 [ sponsors 1 brand new wheelchair ]
CAD $390 [ sponsors 2 brand new wheelchairs ]
CAD $780 [ sponsors 4 brand new wheelchairs ]
CAD $
Credit Card Number (we accept MasterCard, Visa, and American Express)*
Expiration Date* /
Card (CVV) Code (Your credit card verification number is printed on the back of the card. It is the last 3 numbers printed above the signature area)*
Presentation Folder Form
Please indicate if you wish to receive a presentation folder (Please note this only applies to gifts of $195 or more)
If you are not requesting a folder, please skip to the bottom of this form, and click the NEXT button.
Please send me a certificate to read: Canadian Wheelchair Foundation wishes to thank...
Donor (above) Other (fill in below)  
Other
For the gift made...
No designation In the name of In honour of
In memory of  
Name
Mail To
Gift Recipient Street
Gift Recipient City
Gift Recipient Province / State
Gift Recipient Postal Code / Zip
Gift Recipient Country
Comments (Please provide other details here including Council No. / Club Name etc .if applicable)

 








































SAMPLE PRESENTATION FOLDER

Your $190 donation will allow us to deliver a brand new wheelchair into the life of a person in desperate need of mobility. For each $190 donation, you will receive a beautiful presentation folder with the picture of a wheelchair recipient inside.