PRINTABLE MONTHLY DONATION FORM

Please provide the following information:

Name
First Name: Last Name:
Email: Website:
Organization:  
Are you already a member of Animal Alliance? Yes No Not Sure
Address
Street: Town/City:
Province: Postal Code:
Home Phone: Work Phone:
Donation Info
Donate to: Animal Alliance of CanadaAAEVPC  
Comments:
Please indicate the amount you would like to donate:
Monthly Amount: $10 $15 $20 $25 $30Other: $  
Beginning: [..............................................] ,2011  
Payment Type

Bank Account (please send a check marked VOID)

Visa MC
Card Holder:
Credit Card #:
Expiry:  
Special Offer
Please send me my free Animal Alliance tote bag!
I do not want a tote bag!

Animal Alliance Environment Voters Party of Canada (AAEVPC) is a federally registered political party.
Consequently AAEVPC can issue tax deductible receipts.

Animal Alliance is a non-profit organization and is prevented by the government from issuing tax receipts.

Animal Alliance of Canada / AAEVPC
221 Broadview Ave., #101,
Toronto, Ont.
M4M 2G3