Monthly Giving Program - University of Ottawa Heart Institute

Gift Information

A pre-authorized monthly donation is a convenient way to plan your annual gift to the Heart Institute and support innovative cardiac research and the purchase of specialized, life-saving equipment.

IMPORTANT: Once you complete the form below, your first monthly gift will be charged to the card provided. All subsequent donations will automatically be charged on a monthly basis to the card on file. An email containing the confirmation of the charge and a tax receipt will be sent to the email address provided below after each charge made to your credit card. If at any time you wish to change the terms of your monthly gift, please reach out to us at 613-696-7030 or by email at foundation@ottawaheart.ca and we will be happy to assist you.

Gift Information

Field Is Required Select Gift Amount:

$10.00

$20.00

$30.00

$40.00

Enter an Amount

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Yes, I would like to make this donation anonymously

Donor Information

This gift is on behalf of an organization

Yes

Organization:

Title:

First Name:

Last Name:

Email Address:

Street 1:

Street 2:

City:

Province/State:

Postal/ZIP code:

Country:

Phone Number:

Message Body:

Yes, I would like to receive physical communication from this organization.

If you donate and have not already registered, you will receive periodic updates and communications from University of Ottawa Heart Institute.

Billing Information

Please uncheck the box below if your donor information does not match your billing address as it appears on your credit card statement.

Billing information is the same as donor information

Organization:

Title:

First Name:

Middle Name:

Last Name:

Street 1:

Street 2:

City:

Province/State:

Postal Code/ZIP:

Country:

Payment Information

By completing this step, you authorize the storing of this card account for a payment of [AMOUNT] [FREQUENCY] [DURATION].

Payment Method:

Credit Card

Credit Card Information:

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Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

Gift Information

Donor Information

Billing Information

Payment Information

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