TREE OF LIFE PROGRAM ORDER FORM
Please print, complete & mail form to
Villa Charities Foundation 901 Lawrence Ave W. Toronto, Ontario M6A 1C3
Thank you for your donation!    Grazie mille!
DONOR NAME
ADDRESS

HOME

BUSINESS

EMAIL
LEAF:
            $1,000.00
           $250.00 (quarterly)
           $83.34 (monthly)
           other $ 		ROCK:
            $5,000.00
           $1,250.00 (quarterly – 1 year)
           $250.00 (quarterly for 5 years)
           $416.67 (monthly – 1 year)
           other $
METHOD OF PAYMENT:
 Cheque    Money Order    Visa    MasterCard    American Express

Card Holder Name:

Card No.:

Expiry Date:

Signature:
ENGRAVING
   FOR OFFICE USE ONLY

DATE RECEIVED DAY / MONTH / YEAR

DATE ORDERED DAY / MONTH / YEAR

COMPLETED BY:

DATE MOUNTED DAY / MONTH / YEAR
Charitable Business Number: 12364 6374 RR0001 svdsfm0301