Gift Information

Donation Amount*
$

If you are making a donation in tribute to someone Hospice Halifax would be happy to send them a card notifying them or a family member of your donation.

 

Please select the type of tribute applicable for the donation, the name of the tributee and the full name and address of the person to whom a notification card should be addressed.

Tribute Name
Name for Card
Card Address

Donor Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

Security Code