Donation Form
To submit your donation by mail,
please print this donation form and mail to:
Family Services of the North Shore
203-1111 Lonsdale Avenue
North Vancouver, BC V7M2H4


* required field
Step 1 — Donor Information
Date: May 29th, 2017
Are you * an Individual Donor or a Corporate Donor
If corporate donor please state organization name:
Name: *
Title
First
Last
Initial
Billing Address:
  
Street Number *
  
Street Name *
Address Line 2
City *
Province *
Postal Code *
Email *

Alternate #
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Phone # *
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Fax #
- -
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How did you hear about us? *
Step 2 — Gift Information
* Gift Amount Canadian $.00
Is this:    a one time gift or    a monthly gift
Please direct my gift to: *
Is there anything else we need to know about your gift?
My donation is for 
Specify person or occasion (if applicable) 


Please mail acknowledgement of this gift (for In Memory, In Honour or Special occasion gifts only) to:
Name:
Title
First
Last
Initial
Address:
Street Address
Address Line 2
City
Province
Postal Code

Step 3 — Payment Information
Credit Card Type * Visa MasterCard
Credit Card # *
(No spaces)
Name on card *
Expiration Date *     CVC Security Code (3 digit number on back of card) *

Other Information

Tax receipts will be issued according to CRA guidelines.  Tax receipts are issued for gifts of $20.00 or more, a gift of $500.00 or more is recognized in our Annual General Report.

I would like my gift to remain anonymous
I would like to receive periodic updates from Family Services of the North Shore.

Charitable Registration #’s:  FSNS Foundation 864745575RR0001 * FSNS 119061240RR0001

Telephone: 604-988-5281 | Fax: 604-988-3961 | www.familyservices.bc.ca

Simple Spam Protection Question:
Please, only press the Submit button once
or multiple transactions may occur.