On-Line Donation
Become a Hero for Zero and help support the work of HIV Edmonton!
DONOR
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First Name:
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Last Name:
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Email:
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Address1:
Address2:
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City:
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Province:
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Tribute Details:
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DONATION
Amount: $
Donations $20 and above are eligible for a tax receipt
Send tax receipt to the address above
TOTAL
: $
PAYMENT
Payment Method:
Cheque
Credit Card
Payment must be made in person at our office (#301, 11456 Jasper Avenue)
during office hours (Mon - Fri 9:00 am - 5:00 pm)
Please make cheque payable to:
HIV Edmonton
9702 111 Ave. NW
Edmonton AB Canada
T5G 0B1
Frequency:
One Time
Monthly
Card Holder Name:
Card Number:
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We keep your personal information private and secure. When you make a payment through our site, you provide your name, contact information, payment information, and additional information related to your transaction. We use this information to process your payment and to ensure your payment is correctly credited to your account.
Contact Us: HIV Edmonton 9702 111 Avenue Edmonton, AB T5G 0B1 PH: 780-488-5742 e-mail: contact@hivedmonton.com Web:
www.hivedmonton.com