Gift Information

Donation Amount*
  • $25
  • $50
  • $100
  • $250
  • Other $

Contact Information

Contact details in this section appears in the tax receipt that is emailed to you immediately after the donation is made.

Company Name
Country*
Email*
Confirm Email*
Phone*

Recognition Preferences

Preferred Recognition Name (if applicable)

Dedication Information

Please Choose One of the Following:
  • In memory of
  • In honour of
  • No dedication
Enter Name (if applicable):

Other Information

How Did You Hear About Closer to Home?
  • Google
  • Facebook
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  • Twitter
  • Word of Mouth
Other:

Communication Preferences

Your Consent is Desired*
  • By submitting this donation, I understand that I may receive email communications from Closer to Home. I may unsubscribe at any time.

Payment Information

Amount*
$
Payment Type
We only accept credit/debit card payments. After you complete this form, select Submit to enter your card details into our secure transaction processor. Your submission will be processed when you finalize your secure payment information.
Additional Comments
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