Submit by Email Print Form

Laurel Packinghouse Heritage Fund Credit Card Donation Form

Use this form if you are making a donation by credit card. Fill out this form and submit via email by clicking on
the “Submit by Email” button in top right corner. Or, complete all areas, print, and mail to the address at the
bottom of the form.

Check the type of donation you are making:

 I want to make a one time donation of $____________

 I want to make a monthly donation of $ ____________. I understand that my credit card will be
charged on the same business day of every month for two consecutive years.

___ VISA ___ MasterCard

Credit Card Number: ________________________________________ Expiry Date: ___________

Cardholder Name: ______________________ Cardholder Signature: _________________________

If submitting by email, check to indicate your signature:

Please send a charitable tax receipt to: (for gifts $10.00 and over)

Name: _______________________________________________________

Address: ______________________ City: ______________ Province: _____ Postal Code: ________

Telephone: __________________ Email: ___________________________

Gifts in Special Recognition

This gift is: _____ In Memory of _____ To Honour Name: ___________________________________

If you wish a card to be sent on your behalf: (your name only is given)

Name of next of kin/ honouree: ____________________________________

Address: ______________________ City: ______________ Province: _____ Postal Code: ________

Your personal information and gift amount is held in the strictest confidence unless you instruct otherwise. May we include
your name only in our Recognition Program? Yes _____ No _____

THANK YOU FOR YOUR GIFT!

Mail to: Kelowna Museums Society

470 Queensway Avenue
Kelowna, BC, V1Y 6S7

Charitable Tax # 11897 8626 RR0001

Phone: 250-763-2417
LaurelPackinghouse.ca