Chanukah Celebration - Honouring the Windsor Fire Department!

I would like to support the work of the Fire Department with a contribution to the Fire Department's Benefit Fund in honor of Chanukah for the amount of:

$1,000.00 $500.00 $360.00

$180.00 $100.00 $36.00 $18.00

I want to make a contribution of: $  CAD

 

Title*
First Name*
Last Name*
Address Line 1*
Address Line 2
City*
State
Post Code*
Country*
Phone
This is my  home  business address.
Card Type*
Card Number*
Expiration Date*
CVV Security Code 
Acknowledgment
Email Address*
Reconfirm Email Address*
 You may acknowledge my gift to my email address
 Please acknowledge my gift by mail to the above street address.