E-Transfer Donation Form

Charitable Organization Number: 107787087RR0001

Our Vision: People taking control of their health.
Our Mission: To engage our community in co-operative health and wellness.

Donation Information

FUND*
Donation Type*
Price

All donations $20 or greater are tax receiptable.
I would like this donation to be anonymous. Personal information is required to complete all financial transactions and are tax receiptable. By selecting Anonymous, NorWest Co-op Community Health will not contact you based on this donation.
- Anonymous donation
I would like this donation to be anonymous.
Personal information is required to complete all financial transactions and are tax receiptable. By selecting Anonymous, NorWest Co-op Community Health will not contact you based on this donation.
Donor & Tax Receipt Information
Name*
First Last
Donor Type
Company Name
Email
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
E-Transfer Password*

Auto-deposit has been setup however it is recommended that a password be setup as settings may differ at each financial institution and a password may be required.
Dedication Information
Dedication Message
Message to NorWest Co-op Community Fundraising Committee
Optional
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

Once the form has been submitted please complete an E-Transfer through your financial institution to NorWest Co-op Community Health at donate@norwestcoop.ca.

Please note that this form must be completed to ensure a tax receipt can be provided for all donations $20.00 or greater.

Donation Information

Donor & Tax Receipt Information

Dedication Information