Amount being donated

$

Title

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

First Name

Last Name

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 (We will use it for contacting thru WhatsApp)

Email Address

Payment Options

E-Transfer (preferred method) to info@handicareintl.org
Pay by Credit Card, To avoid fees, Select other and enter zero. If you do not want your name displayed, uncheck "Display my name"
Cheque* (payable to Handi-Care Intl. and send to 38, Larwood Blvd, Toronto, Ontario, CANADA M1M 2M5)

Comments (if any)

Your personal information, including phone #, will remain confidential with us. We will NOT share this with anyone or any other organization

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.