Coldwater Canada Monthly Donation Form
Please fill out this form and click submit.
Name
*
Email
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This address will receive a confirmation email
Phone
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Address
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Monthly donation amount you would like to pledge:
*
Preferred Method of Giving
*
Please select one option.
I would like to set up recurring donations with my Visa or Mastercard.
I would like to set up recurring donations through my online bank account.
Select Option
I would like to set up recurring donations with my Visa or Mastercard.
I would like to set up recurring donations through my online bank account.
Donor Type
*
Please select one option.
Personal
Corporate/Group
Select Option
Personal
Corporate/Group
Name of Company/Group
Address
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AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Comments/Questions/Enabling a Team Member?
I would like to receive occasional Coldwater updates, newsletters & reports.
*
Please select one option.
Yes please!
No thank you.
I am already on the list!
Thank you for completing this information. We will be in touch with you shortly regarding your preferred method of giving to get everything set up properly!
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