Donation Form

Yes!! I would like to play a leading role in the Community Fundraising Campaign (donation of $2,500 or more) and have my name included on the donor wall in perpetuity in Pelham's Meridian Community Centre.

Donation Type: *

Corporate

Individual

Surname: *

First name *

Initial

Business/Organization Name: *

Donor's Contact Information:

Address: *

Town/City: *

Province: *

Postal Code: *

Phone: *

Email Address: *

I am pleased to contribute a total of ($2,500 or more)

$ *

payable over *

years (up to a maximum of five years)

I plan to make this gift by:
*

Cheque (please make your cheque payable to the "Town of Pelham")

Credit Card (Town Staff will contact you to obtain your credit card information)

Donor Recognition in Perpetuity:

Please fill in the individual name(s) of company name that you would like prominently displayed on the donor wall in the Atrium Lobby.

Donor or Business/Organization name for display on the donor wall: *