Ontario Lottery & Gaming Donation Form - Federated Health Charities

* Donation information will be shared with the OLG Corporate Campaign Treasurer for tracking and reconciliation purposes.

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

This platform is only for employees of Ontario Lottery & Gaming. If you do not work for Ontario Lottery & Gaming, please return to the previous page, and select the appropriate donation option. *

I confirm that I am an employee of Ontario Lottery & Gaming

NAME AND ADDRESS

Agency *

Division *

Name *

First

Last

Today's date *

City *

Province *

Postal Code *

Phone (office) *

Email *

CONTRIBUTION AND PAYMENT DETAILS

Payroll Deductions or Credit Card Donation *

I AUTHORIZE PAYROLL DEDUCTIONS
I AUTHORIZE A CREDIT CARD DONATION

Time limited deduction or ongoing deduction *

Time limited deduction

Deduction per pay (time limited) *

Amount of pays *

Maximum 26

Total to be deducted *

One-time or Monthly Donation *

One-time donation
Pre-authorized monthly donation

Card Type *

Credit Card Number *

Expiry Date *

3-Digit CVV *

Donation Amount *

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? *

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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