Yee Hong Community Wellness Foundation 頤康基金會

Online Donation Form 網上捐款表格

$ Donation Amount:

Donate every 每捐

Donor Information 捐贈者信息

Salutation

First Name 名字 *

Last Name 姓氏 *

Email Address 電郵地址 *

Phone Number 電話號碼 *

Donation Purpose/Campaign 用途 *

In Honour Of/In Memory Of Name (optional) 為紀念名/表彰名 (可選)

Other remarks (optional) 備註

Tax Receipt Address (if different from Billing Address) 退稅地址（如與帳單地址不同）

Credit Card Info 信用卡資料

This is a secure SSL encrypted payment.

Card Number 卡号 *

CVC号码 *

Cardholder Name 持卡人姓名 *

Expiration *

Billing Address 结算地址

Country 國家 *

Address 1 *

Address 2

City 城市 *

State / Province 州/省 *

Zip / Postal Code 郵政編碼 *

Donation Amount (CAD$) 捐款金額（加元）: $100.00 One Time