OutCare Donation Form
Contact Information
Country*
(None Selected)
Australia
Canada
New Zealand
United States
State / Province*
Address*
City*
State / Province*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*
Language Preference
(None Selected)
English
French
Gift Information
Donation Amount*
$
Donation Frequency*
One Time
Annually
Semi-Annually
Quarterly
Monthly
Weekly
Fund*
Where the Need is the Greatest
COVID-19 Special Support
Please fill in this box if you wish to designate your gift to a certain hospice in Eastern Ontario. 100% of your donation will be given to your charity. If you choose more than one, your gift will be divided accordingly. If you leave this area blank, your gift will go to the area of greatest need. Thank you for your support.
Tribute Information
If this is a tribute gift, please complete the following information.
Is this gift in Memory/Honor/Celebration of someone?
In Honor
In Memory
In Celebration
Tribute Name
Send Notification of Tribute Donation to Family?
Yes
Name and Address of Family Member (required for sending notification)
Payment Information
Amount*
$
Payment Type
We only accept credit/debit card payments. After you complete this form, select
Submit
to enter your card details into our secure transaction processor. Your submission will be processed when you finalize your secure payment information.
Additional Comments
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