Thank you for providing your current information. This will allow us to easily update your record, process your monthly payments and ensure any communications are appropriately addressed. It is important to note that your information is being entered on a secure page and will be updated into our main systems within one week.

Please know that your continuous support is helping to make Sick Kids better and is working towards making the impossible, possible.

If the change you are making is not yet in effect, please provide us with the appropriate effective date.

 

Day: Month: Year:

 *  Denotes Required Field
 

Old Information

New Information

Title:
First Name: *
Last Name:  *
Address Line 1:
Address Line 2:
City:
Province/State:
Postal/Zip Code:  *  
Country:  *
Email address:
Phone (home): ( ) ( )
Phone (business): ( ) ( )
Phone (cell): ( ) ( )
 
For credit card payment changes, please fill in these fields.

Old Information

New Information

Credit Card Type:
Credit Card Number:
Credit Card Expiry Date:
 MM/YY 
 
month
year
 MM/YY 
 
month
year
Name on Credit Card:
 
For automatic bank withdrawal changes, please fill in these fields.

Old Information

New Information

Bank Name:
Bank #s on bottom of cheque:
Cheque details Cheque details
The Hospital for Sick Children Foundation's Pre authorized Debit Agreement

I would like to change my monthly gift amount from $ to
(if you don't want to change your monthly gift, please leave blank)



Type of pre-authorized debit: an Individual a Business

Donor signature(s) authorizing monthly pledge and payment details       Authorization Date

Any old information you can provide, besides the required fields would assist us in updating your information appropriately. For example, your donor id #. Thank You.



(maximum 250 characters)

If you would prefer not to use our online form to communicate your information changes, then please choose from one of these other methods: please fill out the above form and click on the Print button below and fax to 416.813.7969, or call 1.800.661.1083 throughout North America. Outside North America, please call 416.813.7992.