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Gift by Mail or Fax - Monthly Gift


Please print this form and mail or fax it to us.

Multiple Sclerosis Society of Canada
175 Bloor Street E., Suite 700, North Tower
Toronto, ON  M4W 3R8
Fax: 416-922-7538

Asterisk (*) indicates required information

Personal Information

Title:                                               
*Address:                                               
                                                
*Postal Code:                                               
Telephone: (         )                                  
*E-mail:                                               
*Name:                                               
*Town/City:                                               
*Province:                                               
*Country:                                               
Fax: (         )                                  
When you join the fight against multiple sclerosis you will receive the most recent newsletter updates and personalized name and address labels. Please click here if you do not wish to receive our newsletter and personalized address labels.

Donation Information

*I would like to make a single gift donation of: *Receipt type preference:
$5 $7 $10 Other amount $                  E-receipt Mail receipt
Please direct my gift to: Tax receipts for donations under $10 will be provided upon request. My donation is under $10 and I would like to receive a tax receipt.
Research Services Greatest Need

Payment Information

*Please select your payment method:
Charge my credit card
Please note that your card will be billed the amount specified on the 15th of each month.
*Card Type: Visa MasterCard American Express
*Card Name:                                             *Card Number:                                            
*Expiry Date: (mm)               /(yy)              
Make a direct bank withdrawal from my account
Please note that your specified amount will be transferred directly to the MS Society on the 15th of each month. We will contact you to get your bank account details, please provide us with the following information:
Daytime telephone: (         )                                  
Best time to call: