Print out the following form and mail, fax or drop it off at Wyndham House.

Yes! I want to make a gift to support Wyndham House!

Mailing/Drop off information:
Wyndham House
51 Bellevue St.
Guelph, ON N1G 1E9

Mr.

Mrs.

Ms.

Miss

Dr.

Mr. & Mrs.

First Name:
Last Name:
Address:
City:
Province:
Postal Code:
Phone Number:
E-mail:

I would like to make a donation to Wyndham House in the amount of:

$25

$50

$75

$100

Other:

Tax receipts will be issued for all donations of $10 or more.

MasterCard

Cheque

Card Number:
Expiry Date:

Signature:_______________________________

For more information, please call Wyndham House at 519-763-8040.