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Required Fields
Donation Information
Amount
$20
$50
$100
$250
$500
Type of Donation
One Time Donation
Recurring Donation
Frequency
Monthly
Complete the following fields if this gift is a tribute.
(optional)
Type of tribute
In memory of
In Honor of
Tribute Name
Would you like the person to know about your contribution?
Yes
No
If yes, please provide the email address of the contact person.
Email
Contact Information
Donor Type
Personal
Corporate
Title
Mr.
Mrs.
Mx.
First Name
Last Name
Company Name
Language
English
French
Address
City
Province
Alberta
Colombie-Britannique
Île-du-Prince-Édouard
Manitoba
Nouveau-Brunswick
Nouvelle- Écosse
Nunavut
Ontario
Québec
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Terre-Neuve-et-Labrador
Territoires-du-Nord- Ouest
Yukon
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Arizona
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Virginie
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Wisconsin
Wyoming
Autre
Postal Code
Phone
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For all donations of $5,000 or more, the Foundation offers you the possibility of displaying your contribution on its website. Would you like your name or your company's name to be included?
Yes
No
I consent to the collection, use, and disclosure of my personal information collected through this form in accordance with the terms described in the Lise Watier Foundation’s
Privacy policy
for the purpose of collecting monthly replenishment amounts and/or occasional one-time payments for the settlement of all amounts charged to my account(s) with the Lise Watier Foundation.
Please select YES to give your consent
Yes
Credit Card Information
Card Holder Name
Visa
MasterCard
Card Account Number
Expiry Date
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
24
25
26
27
28
29
30
31
32
33
34
Security Code
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Billing Address
Same As Above
Address
City
Province
Alberta
Colombie-Britannique
Île-du-Prince-Édouard
Manitoba
Nouveau-Brunswick
Nouvelle- Écosse
Nunavut
Ontario
Québec
Saskatchewan
Terre-Neuve-et-Labrador
Territoires-du-Nord- Ouest
Yukon
Alabama
Alaska
Arizona
Arkansas
Californie
Caroline du Nord
Caroline du Sud
Colorado
Connecticut
Dakota du Nord
Dakota du Sud
Delaware
Floride
Georgie
Hawaï
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiane
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New York
Nouveau-Mexique
Ohio
Oklahoma
Oregon
Pennsylvanie
Puerto Rico
Rhode Island
Tennessee
Texas
Utah
Vermont
Virginie
Virginie-Occidentale
Washington
Wisconsin
Wyoming
Autre
Postal Code
Email
Your entry is not a valid email address!
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Privacy Policy
We keep your personal information private and secure. When you make a payment through our site, you provide your name, contact information, payment information, and additional information related to your transaction. We use this information to process your payment and to ensure your payment is correctly debited to your account.
Contact Us
LISE WATIER FOUNDATION •• 2170 René-Lévesque Blvd W., office 201, Montreal (Quebec), H3H 2T8 •• 514-507-6881 ••
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