Metrolinx Donation Form - Federated Health Charities

315 Front Street W, 5th Floor
Toronto, ON M7A 0B8
Telephone: 437-925-6227
federatedhealth.ca

NAME AND ADDRESS

Agency

Division (name or number)

Name

First

Last

Today's date

City

Province

Postal Code

Phone (office)

Email

CONTRIBUTION AND PAYMENT DETAILS

Payroll deductions

I AUTHORIZE PAYROLL DEDUCTIONS:

Time limited deduction or ongoing deduction

Time limited deduction
Ongoing deduction

Deduction per pay (time limited)

Deduction per pay (ongoing deduction)

Pledge renewal enrollment

AUTOMATIC PLEDGE RENEWAL ENROLLMENT: I agree to have my payroll deduction as described above, automatically renew on an ongoign basis.

Amount of pays

Maximum 26

Total to be deducted

Employee #

Signature

Please type your name.

I WISH MY DONATION TO GO TO:

ALL 21 HEALTH CHARITIES (Vendor #200)
THE CHARITIES I HAVE CHOSEN

Canadian Cancer Society

Canadian Cancer Society (Vendor #203)

Donation to Canadian Cancer Society (Vendor #203)

Heart & Stroke

Heart & Stroke (Vendor #204)

Donation to Heart & Stroke (Vendor #204)

Diabetes Canada

Diabetes Canada (CDA/JDFC) (Vendor #205)

Donation to Diabetes Canada (CDA/JDFC) (Vendor #205)

Hemophilia Ontario

Hemophilia Ontario (Vendor #206)

Donation to Hemophilia Ontario (Vendor #206)

Spinal Cord Injury Ontario

Spinal Cord Injury Ontario (Vendor #207)

Donation to Spinal Cord Injury Ontario (Vendor #207)

The Kidney Foundation of Canada

The Kidney Foundation of Canada (Vendor #208)

Donation to The Kidney Foundation of Canada (Vendor #208)

Lung Health Foundation

Lung Health Foundation (Vendor #209)

Donation to Lung Health Foundation (Vendor #209)

Alzheimer Society of Ontario

Alzheimer Society of Ontario (Vendor #210)

Donation to Alzheimer Society of Ontario (Vendor #210)

The Arthritis Society – Ontario Division

The Arthritis Society – Ontario Division (Vendor #211)

Donation to The Arthritis Society – Ontario Division (Vendor #211)

Crohn’s and Colitis Canada

Crohn’s and Colitis Canada (Vendor #212)

Donation to Crohn’s and Colitis Canada (Vendor #212)

Ontario Federation for Cerebral Palsy

Ontario Federation for Cerebral Palsy (Vendor #213)

Donation to Ontario Federation for Cerebral Palsy (Vendor #213)

Cystic Fibrosis Canada

Cystic Fibrosis Canada (Vendor #214)

Donation to Cystic Fibrosis Canada (Vendor #214)

Canadian Liver Foundation

Canadian Liver Foundation (Vendor #215)

Donation to Canadian Liver Foundation (Vendor #215)

Ontario AIDS Network

Ontario AIDS Network (Vendor #216)

Donation to Ontario AIDS Network (Vendor #216)

Osteoporosis Canada

Osteoporosis Canada (Vendor #217)

Donation to Osteoporosis Canada (Vendor #217)

Institute for Advancements in Mental Health

Institute for Advancements in Mental Health (Vendor #218)

Donation to Institute for Advancements in Mental Health (Vendor #218)

ALS Society of Canada

ALS Society of Canada (Vendor #219)

ALS Society of Canada (Vendor #219)

MS Society of Canada

MS Society of Canada (Vendor #220)

MS Society of Canada (Vendor #220)

Parkinson Canada

Parkinson Canada (Vendor #221)

Parkinson Canada (Vendor #221)

Autism Ontario

Autism Ontario (Vendor #222)

Autism Ontario (Vendor #222)

Sickle Cell Awareness Group of Ontario

Sickle Cell Awareness Group of Ontario (Vendor #223)

Sickle Cell Awareness Group of Ontario (Vendor #223)

DONATE TO CELEBRATE OR REMEMBER

Type of dedication (optional)

In memory of
In honour of
None

The name of the person you dedicate this donation to:

Do you want us to notify anyone of this donation?

Yes
No

Please provide us with the name of the person you want us to notify of this donation.

Do you want us to send

a hard copy card
an e-card

Please provide us with the mailing address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Please provide us with the email of the person you want us to notify of this donation.

PRIVACY & TAX RECEIPTS

• Tax receipts will be issued for gifts of $25 and over.

• Gifts made by payroll deduction are recorded for income tax credit on box 46 of your T4 slip.

Privacy: Individual donor information is maintained in order to issue income tax credit under the regulations of the Canada Revenue Agency. This information is maintained in a strictly confidential manner and is never traded, rented, sold or otherwise revealed to any organization in whole or in part — including the charities that benefit from the campaign.

CHARITABLE REGISTRATION NO. 85413 5480 RR0001

FEDERATED HEALTH CHARITIES CORPORATION

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