Corporate Donations
	Please print this form and send with your cheque or credit card payment to: Epilepsy Toronto 510 King Street East Suite 224 Toronto, ON M5A 1M1 Support quality programs and services for the thousands of people in Toronto who are living with epilepsy by making a tax-deductible contribution to Epilepsy Toronto in the amount of: $100       $500       $1000       Other   __________ Method of payment:    Cheque     VISA       Mastercard Card number: _________________________________________ Expiry date: ______________ Signature: ___________________________________________ * Tax receipts provided Contact Name:  _________________________________________ Title:  _________________________________________________ Company:  _____________________________________________ Address:  ______________________________________________ City:  __________________ Prov:   ___________ P.O.   _________ Phone:  ______________________  Fax:  ____________________ E-Mail:   _______________________ Top of the page
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