DONATION AMOUNT
I would like to donate the following amount: (please circle)
25 50 100 200 500 1000
Other amount: ________________________________
* Donations made are tax deductible for Canadian
Tax Payers for the amount of $50 CAD or more.
If you are eligible and require a receipt, please circle
one of the following:
Yes, I require a tax receipt
No, I do not require a tax receipt
Currency (please circle)
CAD USD EURO GBP AU NZ
PAYMENT DETAILS
Please indicate how you wish to pay: By Credit Card:
VISA or MasterCard (please circle)
Card #________________________________
Expiration Date _____/_____ (yr/mo)
Cardholder Name_______________________
Signature______________________________
* Charges to your credit card will be based on
the CAD$ exchange rate at the time of your
donation.
Cheque or Money Order (please circle)
* Please note that cheques and money orders can only
be accepted for CAD or USD
* Cheques and money orders should be made out to
the Planeterra Foundation
DONOR INFORMATION Note: If applicable, Charitable Tax Receipts will be issued to
this address
Name
: Address:
City
: Province or State:
Country: Postal or Zip Code:
Tel #:
Email
:
By sponsoring the Planeterra Jump for Charity, you will be helping to support community
projects in
Latin America that focus on the areas of health, education, childcare, community development
and
environmental conservation. For more information about Planeterra, visit
www.planeterra.org
Jump For Charity
Donation Form
Please send this form along with your donation to:
Planeterra Foundation
355 Eglinton Ave East, Toronto, ON, M4P 1M5, Canada
Or if paying by credt card you can fax it to:
(416) 260-1888
