Donation Form

Step 1: Choose one of the following options



One-time Donation Monthly Donation

* Amount: $

* Begin:
* End:


Step 2: Allocation of Funds



I would like my donation to be directed towards:


Step 3: Your Contact Information



Individual Company Fundraiser

* Title:
* First Name:
* Last Name:
* Company:
* E-mail:
* Telephone: - -
* Fax: - -
* Address:
* Apt. / Suite:
* City:
* Province:
* Country:
* Postal Code:
* Language of Correspondence:
* Message:

Step 4: Method of Payment



Visa MasterCard American Express

* Credit Card Number: - - -
* Card Verification Number:  
Card Verification Number

The last 3 digits located on the back of your Visa or Master Card or located on the front of your American Express.
* Expiration Date:
* Cardholder's Name:


Step 5: This is a donation



in memory of in honour of none of these choices

* Title:
* First Name:
* Last Name:

Please send an acknowledgement to


* Title:
* First Name:
* Last Name:
* Company:
* Address:
* Apt. / Suite:
* City:
* Province:
* Country:
* Postal Code:
* Language of Correspondence:
* Relationship to person:
* Message:


Step 6: End of Transaction




( * ) Required fields

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Donations and Administration:
Enfant-Retour Québec
6830, Park Avenue, Suite 420
Montreal, QC H3N 1W7
Telephone: (514) 843-4333

A receipt will be issued for donations of 15.00$ and more.
Charitable Registration Number: 10788 6863 RR0001