“Walk on” for CARD ~ PLEDGE FORM
Sunday June 22, 2014
Charitable #11887 0138 RR0001
Donor (First Name / Last Name):
Address:
City:
Province:
Telephone:
Cell:
Apt/Suite/Unit:
Horse:
Postal Code:
Walk Time:
Participant Email:
(Tax receipt issued for donations of $20.00 and over)
1
Donor (First Name / Last Name):
City:
Home Street / Apt. / Unit #:
Prov:
Donor (First Name / Last Name):
City:
Home Street / Apt. / Unit #:
Prov:
Donor (First Name / Last Name):
City:
Home Street / Apt. / Unit #:
Prov:
Donor (First Name / Last Name):
City:
Home Street / Apt. / Unit #:
Prov:
Donor (First Name / Last Name):
City:
Home Street / Apt. / Unit #:
Prov:
Donor (First Name / Last Name):
City:
Home Street / Apt. / Unit #:
Prov:
Donor (First Name / Last Name):
City:
Home Street / Apt. / Unit #:
Prov:
Donor (First Name / Last Name):
City:
Home Street / Apt. / Unit #:
Prov:
Donor (First Name / Last Name):
City:
Home Street / Apt. / Unit #:
Prov:
Donor (First Name / Last Name):
City:
Home Street / Apt. / Unit #:
Prov:
Credit Card Number:
Pledge Amount $
Exp. Date:
CA
CQ
Postal Code:
Telephone:
CC
2
Credit Card Number:
Tax Receipt
Yes
No
Exp. Date:
CA
CQ
Postal Code:
Telephone:
CC
3
CA
CQ
Credit Card Number:
Postal Code:
Telephone:
CC
4
Credit Card Number:
Tax Receipt
Yes
No
Exp. Date:
Tax Receipt
Yes
No
Exp. Date:
CA
CQ
Postal Code:
Telephone:
CC
5
Credit Card Number:
Tax Receipt
Yes
No
Exp. Date:
CA
CQ
Postal Code:
Telephone:
CC
6
Credit Card Number:
Tax Receipt
Yes
No
Exp. Date:
CA
CQ
Postal Code:
Telephone:
CC
7
Credit Card Number:
Tax Receipt
Yes
No
Exp. Date:
CA
CQ
Postal Code:
Telephone:
CC
8
Credit Card Number:
Tax Receipt
Yes
No
Exp. Date:
CA
CQ
Postal Code:
Telephone:
CC
9
Credit Card Number:
Tax Receipt
Yes
No
Exp. Date:
CA
CQ
Postal Code:
Telephone:
CC
10
Credit Card Number:
Tax Receipt
Yes
No
Exp. Date:
CA
CQ
Postal Code:
Telephone:
CC
FOR OFFICE USE ONLY
CASH
CHEQUE
M/C
VISA
$________
$________
$________
$________
TOTAL
$________
Thank you for supporting
The Community Association for
Riding for the Disabled!
Tax Receipt
Yes
No
PLEASE MAKE
CHEQUES
PAYABLE
TO: CARD
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