✁

PLEASE Mail this form with your

#400
Empty
Maildonation
– 2985
Stocking
to: The
this form with
VirtualFund,
Way,4543
your Province
Suite
donation Empty
Vancouver,
Canada
1-200
to: The Stocking
BC V5M
Way,
Granville
Province Fund
4X7 BC V5GBC
Burnaby,
St., Vancouver, 4T4.
V6C 3N3

DONATE Donor Name:_____________________________________________________________________

Donor Address:___________________________________________________________________

TODAY! City:_________________________________
Phone: (
Postal Code:______________________________
) _______________________ E-mail: ______________________________________

Panel Code:
I would like to donate: q $25 q $50 q $75 q $100 q Other $_____________
q My cheque or money order payable to The Province Empty Stocking Fund
q I prefer to use my credit card. Please charge my q VISA q MASTERCARD q AMEX
Card holder name: ________________________________________________________________
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Signature:_______________________________________________________________
ment/. Your personal information shall only be used by Postmedia and/or any third party to
process and/or administer your donation and, where consented to, contact you about future ❑ I I give
q giveThe
TheProvince
Provincenewspaper
permissionpermission
to contacttome by email
contact foremail
me by promotional and communications
for promotional purposes.
and communications purposes.
donations, to respond to your information requests, to familiarize ourselves with our donors,
to periodically send you information on The Province Empty Stocking Fund and to thank you
and recognize your gift. Donations and tax receipts administered by United Way of the Lower
Qualified donations
Qualified donations ofof $10.00 or more
more will
will be
be issued
issuedananofficial
officialtax
taxreceipt.
receiptTax receipts
from Unitedwill
Waybe of
issued
the Lower
Mainland: Charitable Registration No. (BN)108160185. in the name
Mainland. Taxofreceipts
the credit card
will be holder
issued or
in the
thedrawer
name ofof the
the cheque.
credit card holder or the drawer of the cheque.