Make A Gift - Queensway Carleton Hospital Foundation

Donate to Queensway Carleton Hospital Foundation

Your gift ensures that our hospital will continue to improve and enhance our outstanding patient care.

Charitable tax receipts for income tax purposes are issued automatically for donations $10.00 and over.

* = Required fields

Field Is Required Enter A Gift Amount:

$500.00

$250.00

$100.00

$50.00

$36.00

Other Amount

Enter amount

Yes, automatically repeat this gift every month.

Field Is Required Gift Designation:

Use my gift where it is needed most.

Direct my gift to:

Gift In Memory/In Honour Information

Yes, this is a gift in memory or in honour.

Honour Gift Type:

In Memory of/In Honour of (Name):

Name of person you would like us to notify that this gift has been made:

Notification Recipient Address:

Notification Recipient City:

Notification Recipient Province:

Notification Recipient Postal Code:

Who would you like us to say this gift is from?:

Donor Information

Make this gift on behalf of an organization

Organization Name:

Donor Title:

Donor First Name:

Donor Middle Name:

Donor Last Name:

Donor Street 1:

Donor Street 2:

Donor City:

Donor Province/State:

Donor Postal/ZIP code:

Donor Phone Number:

Donor Country:

Billing Information

Billing Information is the same as Donor Information

Title:

First Name:

Last Name:

Street 1:

Street 2:

City:

Province / State:

Postal / Zip Code:

Email Address:

Yes, I'd like to receive email updates from Queensway Carleton Hospital Foundation.

Payment Information

Credit Card Information:

Credit Card Type:

Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

3045 Baseline Road,
Ottawa, Ontario K2H 8P4
Phone: 613-721-4731 Fax: 613-721-4755
Email: qchfound@qch.on.ca
Charitable Organization # 137253571RR0001