F unds S ub m i ss ion F orm

Project contribution funds: Please photocopy and send in this form every time you send in money Name: ________________________________ Project Code: __________________________ Sent to date: __________________ Enclosed: __________________ New Total: __________________

Any donation that has been tax receipted is not eligible for a refund.
Method of Payment
(check one) Cheque Credit card

Author of Cheque
(If a cheque is enclosed)

Name of Donor
(If different from author of cheque)

Tax Receipt Required?

Yes No

Address of Donor
(full mailing when tax receipt is required)

Amount/ Value of Donation

Cheque Credit card

Yes No

Cheque Credit card

Yes No

Cheque Credit card

Yes No

Cheque Credit card

Yes No

Youth Challenge International

555 Richmond St. W., Suite 313, PO Box 1205, Toronto, ON, M5V 3B1 T: 416.504.3370 | F: 416.504.3376 | generalinfo@yci.org | www.yci.org | Registered Charitable Number: 11906 9078 RR0001