Gift Recipient's Full Name

Recipient's Email Address

Occasion Date

Occasion

--Please Select-- Assistive Device Meals for children with disabilities General Donation

Amount being donated

$

Donor Information

Title

--Please Select-- Mr. Mrs. Ms. Miss. Dr.

First Name of donor

Last Name of donor

Have you donated to HCI before?

Yes             No

How did you hear about us?

Web search        From a friend            Other

Specify

Address

City

Province, Country

Zip

Mobile Number of donor (For WhatsApp notificaion)

Email Address of donor

Payment Options

E-Transfer (preferred method) to info@handicareintl.org (Not available for out of Canada donors)
Pay by Credit Card, You need not add the suggested contribution. Select other and enter zero or any amount of your choice.
Cheque Payable to Handi-Care Intl., 38, Larwood Blvd, Toronto, Ontario, CANADA M1M 2M5

Comments (If there are mutiple donors, please add their names here)

Note: A certificate will be created and emailed to the recipient upon receiving the donation from the donor. (A copy will be emailed to the donor as well)

All fields must be filled. Filling form is essential.

* If you want to pay by cheque, please send it to the following address:
Handi-Care Intl., 38, Larwood Blvd, Toronto, Ontario, CANADA M1M 2M5

Important for USA and out of Canada donors: We CAN NOT accept e transfers from a non-Canadian bank. Please pay through Pay by Credit Card, You need not add the suggested contribution. Select other and enter zero or any amount of your choice.

Tax receipt for the donation will be sent to the donor.

Sample Certificate