| (City) | (Province) | (Postal code) |
| Please find enclosed my cheque payable to Chinese Cultural Centre of Greater Toronto | ||||||||||||||||||
|
Please charge my credit card:
Credit Card Number Expiry Date ___________________________________ I would like to help keep costs down by choosing pre-authorized payments. | ||||||||||||||||||
| I hereby authorize Chinese Cultural Centre of Greater Toronto to make automatic MONTHLY withdrawals from my bank account or credit card, as indicated. I understand that I may cancel this authorization at any time by notifying the Centre in writing. | ||||||||||||||||||
| I have enclosed a blank cheque marked “VOID” for pre-authorized payment banking information. | ||||||||||||||||||
| Signature | Date |
Please send cheque with this form to:
Chinese Cultural Centre of Greater Toronto
5183 Sheppard Avenue East, Scarborough, Ontario, M1B 5Z5