Automatic Special Action Fund Donation Application
COPA is introducing a great
new way for you to donate to the Special Action Fund! Sign up now for the
Automatic Special Action Fund Donation and we will charge your credit card
monthly the amount of your choice. NOTE: Since the SAF is not a charity,
donations are not eligible for tax receipts. You will, however, receive a
receipt annually for your records.
| Name: |
Member No: |
| Address: |
| |
| Donation: |
$25 |
$50 |
$100 |
or Specify Amount: |
| |
| Donation information: |
| Visa |
MasterCard |
| Credit Card No.: |
| Expiry Date: |
Name on Card: |
| Signature: |
| |
| I Agree:
By signing below you are authorizing COPA to
debit your credit card account monthly for the amount stated. It is the
responsibility of the member to notify COPA of any changes to your credit
card. (For example: Expiry Date) |
| Signature: |
Date: |
Please fill out this form and return to:
Mail:
COPA Special Action Fund, 207-75 Albert St.,
Ottawa, ON, Canada, K1P 5E7
Fax:
(613) 236-8646
|