Required fields are marked with asterisks (*)

Brant Community Health Hub Donation

** All Donations are processed in Canadian Dollars

IMPORTANT: To ensure that you move through all of the steps required to complete this online service, please use the blue buttons in this form and do not use the Back/Forward button in your internet browser.

Purpose

To make a donation by Debit Visa or credit card. If you have any questions regarding this form, please contact the Revenue Division

Notice of Collection

Personal information contained on this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, c. 25 and will be used for the purposes of administering your request. Questions about this collection should be directed to the Supervisor of Information Services

Donation Amount
 
Make your donation in memory, honour or in celebration of someone or from a Business
 
Are you a member of Primacare?
 
Would you like to be recognized for your donation?
 


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