Offline Donations – Losier Foundation

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Offline Donations

1Donation Type

2Tribute Gift

3Donor Information

One time or monthly donation?*
- One time
- Monthly
Is this an In Honour/Memorial gift?
- No
- Yes
Donation type
- Individual
- Business
- Community Group/Organization
I am supporting
Product Name
- $25
- $50
- $100
- $200
- $500
- $1000
- Other
Enter Amount

Choose one of the following
Tribute Name:
How would you like to send your tribute card?
- E-card
- No card
An e-card will be sent to the recipient of your donation. Please enter their name and email below.
Recipient Name
First Last
Recipient Email
Enter Email Confirm Email
Personal message

Your Name
First Last
Business Name
Organization / Group Name
Contact Name
Contact Information
Address
Street Address City State / Province / Region ZIP / Postal Code Country