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Frequency
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Complete the following fields if this gift is a tribute.
(optional)
Type of Tribute
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In Honour of
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(optional)
:
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Mr.
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Last Name
Address
Address 2
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Title
Mr.
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*
Last Name
/
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Address
Address 2
*
City
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*
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*
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*
Email
Help Us Cover Costs
Simply leave "Yes!" checked below to ensure that 100% of your intended donation is available for our mission.
Yes! I want $0.00 to go to The Argenteuil Hospital Foundation and I will donate $0.00.
No. I will donate $0.00 and The Argenteuil Hospital Foundation will cover the processing costs.
Payment Information
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Address
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California
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Washington, DC
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Florida
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Iowa
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other
*
Country
Canada
United States
Other
*
Postal Code
*
Phone
Email
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provided
above
will be stored securely via SafeSave™ for automatic processing of your future payments.
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Contact Us
THE ARGENTEUIL HOSPITAL FOUNDATION
145 avenue de la Providence, Lachute (Québec) J8H 4C7 •• (450) 562-3761 Ext. 72100 ••
[email protected]
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