Name
Company/Organization (if applicable)
Phone
Email
I prefer to be contacted by:PhoneEmail
Mailing Address
Mailing Address Line 2
City
Postal Code
I would like my pledge to start on the below date. A reminder one month in advance of your pledge payment due date will be sent.
I prefer to complete my $5,000 pledge every year in:Single Annual Gift ($5,000)Monthly Gifts ($416.67)
I would like to fulfill my pledge via: Cheques to each organizationDirect Debit (enter bank details below)Credit Card (enter card details below)Gift of Securities (Foundation Office will contact)
Direct Debit:Bank Name
Transit Number:
Account Number:
Institution Number:
Credit Card: Indicate Card Type :Visa/Mastercard/AMEX
Card Number:
Expiry
CVC Number:
I agree this pledge will be in perpetuity, unless I contact SMHF to request otherwise.
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