Jamaican Self-Help
P.O. Box 1992
Peterborough, ON
K9J 7X7
(705) 743-1671
fax 743-4020
BN 897337150RR0001
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I authorize Jamaican Self-Help to receive:
__ MONTHLY __ ONE TIME
tax-deductible donations from my special
account (see below) in the amount of:
__ $25 __ $50 __ $75 __ Other: $___________
Please charge my gift to :
__ Visa __ Mastercard
Card #:__________________________________
Expiry Date:_______________
Signature:_______________________________
This is a one-time donation (cheque enclosed) for the amount of $____________
Please fill in mailing information for tax receipt purposes.
Name:______________________________________________________________
Address:_____________________________________________________________
City:__________________ Province:______________ Postal Code:___________
| Thank you. An official tax receipt will be issued. |
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