Community Vision Care

Contact Information

This information will be used to build your tax receipt.

Is this a corporate or individual gift? Required Field

Is this a corporate or individual gift? This is a corporate gift. (Please split company name over First Name and Last Name fields.)
This is an individual gift.

First Name: Required Field

Last Name: Required Field

Email:

Address Line 1: Required Field

Address Line 2:

Address Line 3:

City:

Province/State: Required Field

Postal/ZIP: Required Field

Country:

Phone Number: Required Field

Are you interested in making a planned gift?

I have included a gift to Waterloo in my will or another asset e.g. life insurance.

Please send me information about making a gift in my will.

Is this a joint gift with your partner/spouse?

I am making this gift on behalf of me and my partner/spouse.

Partner/Spouse First Name:

Partner/Spouse Last Name:

Partner/Spouse Class Year (if applicable):

Is this gift in memory or honour of someone special?

Tribute Type:

First and Last Name of Deceased or Honouree:

If you would like us to notify the next of kin or honouree of your gift, please provide their contact information:

First and Last Name:

Mailing Address:

City:

Province/State:

Postal/ZIP:

Country:

Does your employer match charitable donations?

Find out if your employer matches gifts:

Do you have any comments?

Comments:

Community Vision Care

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