Laurel Packinghouse Development Fund Credit Card Donation Form

Use this form if you are making a donation by credit card. Print out this page, complete all areas 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 first business day of every month for two consecutive years.

___ VISA ___ MasterCard

Credit Card Number: ________________________________________ Expiry Date: ___________

Cardholder Name: ______________________ Cardholder 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