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Holland
College Donor Form
Name(s): _______________________________________
Alum # (if known): _____________
Address: _______________________________________ Phone
(H): ____________________
City: ___________________ Prov/State:
_____Postal/Zip: __________ Country:
___________
Email:
_______________________
In support of
Holland College, I would like to
make the following donation: $________
Gift Designation
| Student Award
|
Program: |
_____________ |
| Equipment
|
Program: |
_____________ |
| Resources
|
Program: |
_____________
|
| Other designation (please specify):
|
|
_____________ |
| Use this
gift where it is most needed: |
 |
|
Method of Payment (Please
check the box beside your method of payment)
Bequest (Make
arrangements with Holland College Foundation staff) _____
Cheque/Money Order enclosed (Payable to Holland College)_____
Post-dated Cheque(s)_____
Mastercard
Visa _____ Expiry Date: ___/___
Credit Card Number: _______/_______/_______/_______
_____________________________________________________
Cardholder's signature (please sign for validation)
Payment Schedule:
Please charge:
Monthly
Quarterly Semi-annually
Annually
Installments of $_________For a total of
$___________________Beginning: ___/___
An official charitable receipt will be issued under
the Charitable Registration Number - 11895 9121 RR0001
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