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CORPORATE DONATION FORM
Name:__________________________________ Address:____________________________________________________________ Postal Code:___________________ Country:___________________ Donation Amount:_____________________ Donation Levels: Supporter: $500 to $2,499 | Friend: $2,500 to $7,499 | Patron: $7,500 to $24,999 * $25,000 and over — contact CCA office METHOD OF PAYMENT Cheque/Money Order: Please make cheque/money order payable to Canadian Cycling Association (send via mail with completed form) Credit Card: ___ Visa ___ Mastercard ___ American express Card #____________________________ Expiry Date:______________ Name on card: ____________________________ Signature: ____________________________ (mail in only) Thank you for your support - it is greatly appreciated! A tax receipt will be mailed to you at the address indicated above. 203 - 2197 Riverside Drive, Ottawa, Ontario, K1H 7X3 |