1. St. Matthew’s Bracondale House
707 St. Clair Ave. West
Toronto, Ontario M6C 4A1 Tel: 416.656.2669
www.smbh.ca Email: hazelton@smbh.ca Fax: 416.656.8052
3 Yes, I will help give the seniors at SMBH the quality of life they deserve!
Donor Name
Donor Address Line 1
Donor Address Line 2
Step 1: Gift Amount
r $200 r $150 r $100 r $50 r Other (Please Specify) $_______
Become a Monthly Donor!
The best way to make a difference in the lives of the seniors of Toronto is to become a regular donor.
For even a small amount every month, you can change a life! Please see other side.
Step 2: Select a payment option
r Cheque (Made payable to St. Matthew’s Bracondale House)
r Credit Card
r Visa
r MasterCard
Card#
Expiry Date
Name as it appears on the card
Cardholder’s Signature: (please sign for validation)
Your personal information is used only for SMBH’s campaigns, administering your donation,
contacting you for renewal, responding to your information requests, to know who our
donors are, to send you literature on SMBH, to invite you to events and to recognize your
gifts. If you would prefer not to be contacted by SMBH you may opt out here. r opt out
Charitable Number: 10803 1295 RR 0001
Tax receipts are issued for gifts of $10 or more.
Solicitation Code:
SMBH depends on individual generosity to provide seniors the resources they need to live a long, full life. Currently SMBH does not exchange
mailing lists with other charitable organizations; however, it may do so in the future. If you would prefer that your name is not available,
please check this box. r
St. Matthew’s Bracondale House
707 St. Clair Ave. West
Toronto, Ontario M6C 4A1 Tel: 416.656.2669
www.smbh.ca Email: hazelton@smbh.ca Fax: 416.656.8052
3 Yes, I will help give the seniors at SMBH the quality of life they deserve!
Donor Name
Donor Address Line 1
Donor Address Line 2
Step 1: Gift Amount
r $200 r $150 r $100 r $50 r Other (Please Specify) $_______
Become a Monthly Donor!
The best way to make a difference in the lives of the seniors of Toronto is to become a regular donor.
For even a small amount every month, you can change a life! Please see other side.
Step 2: Select a payment option
r Cheque (Made payable to St. Matthew’s Bracondale House)
r Credit Card
r Visa
r MasterCard
Card#
Expiry Date
Name as it appears on the card
Cardholder’s Signature: (please sign for validation)
Your personal information is used only for SMBH’s campaigns, administering your donation,
contacting you for renewal, responding to your information requests, to know who our
donors are, to send you literature on SMBH, to invite you to events and to recognize your
gifts. If you would prefer not to be contacted by SMBH you may opt out here. r opt out
Charitable Number: 10803 1295 RR 0001
Tax receipts are issued for gifts of $10 or more.
Solicitation Code:
SMBH depends on individual generosity to provide seniors the resources they need to live a long, full life. Currently SMBH does not exchange
mailing lists with other charitable organizations; however, it may do so in the future. If you would prefer that your name is not available,
please check this box. r
St. Matthew’s Bracondale House
707 St. Clair Ave. West
Toronto, Ontario M6C 4A1 Tel: 416.656.2669
www.smbh.ca Email: hazelton@smbh.ca Fax: 416.656.8052
3 Yes, I will help give the seniors at SMBH the quality of life they deserve!
Donor Name
Donor Address Line 1
Donor Address Line 2
Step 1: Gift Amount
r $200 r $150 r $100 r $50 r Other (Please Specify) $_______
Become a Monthly Donor!
The best way to make a difference in the lives of the seniors of Toronto is to become a regular donor.
For even a small amount every month, you can change a life! Please see other side.
Step 2: Select a payment option
r Cheque (Made payable to St. Matthew’s Bracondale House)
r Credit Card
r Visa
r MasterCard
Card#
Expiry Date
Name as it appears on the card
Cardholder’s Signature: (please sign for validation)
Your personal information is used only for SMBH’s campaigns, administering your donation,
contacting you for renewal, responding to your information requests, to know who our
donors are, to send you literature on SMBH, to invite you to events and to recognize your
gifts. If you would prefer not to be contacted by SMBH you may opt out here. r opt out
Charitable Number: 10803 1295 RR 0001
Tax receipts are issued for gifts of $10 or more.
Solicitation Code:
SMBH depends on individual generosity to provide seniors the resources they need to live a long, full life. Currently SMBH does not exchange
mailing lists with other charitable organizations; however, it may do so in the future. If you would prefer that your name is not available,
please check this box. r

2. St. Matthew’s Bracondale House
707 St. Clair Ave. West
Toronto, Ontario M6C 4A1 Tel: 416.656.2669
www.smbh.ca Email: hazelton@smbh.ca Fax: 416.656.8052
3 Yes, I will become a monthly donor, and provide seniors with the
community support they need all year round!
Step 1: Select a gift size
r $10 r $15 r $20 r $30 r Other (Please Specify) $_______
Step 2: Select a payment option
r Cheque (Enclose a blank cheque markedVOID)
r Credit Card
r Visa
r MasterCard
Card#
Expiry Date
Name as it appears on the card
Cardholder’s Signature: (please sign for validation)
To make a one time gift only, please see other side
r I understand that I can cancel my monthly gift at any time simply by contacting SMBH, and that I will
be issued one tax receipt at the end of each year, for the sum of all my monthly gifts.
SMBH depends on individual generosity to provide seniors the resources they need to
live a long, full life. Currently SMBH does not exchange mailing lists with other charitable
organizations; however, it may do so in the future. If you would prefer that your name is not
available, please check this box. r
Charitable Number: 10803 1295 RR 0001
Tax receipts are issued for gifts of $10 or more.
St. Matthew’s Bracondale House
707 St. Clair Ave. West
Toronto, Ontario M6C 4A1 Tel: 416.656.2669
www.smbh.ca Email: hazelton@smbh.ca Fax: 416.656.8052
3 Yes, I will become a monthly donor, and provide seniors with the
community support they need all year round!
Step 1: Select a gift size
r $10 r $15 r $20 r $30 r Other (Please Specify) $_______
Step 2: Select a payment option
r Cheque (Enclose a blank cheque markedVOID)
r Credit Card
r Visa
r MasterCard
Card#
Expiry Date
Name as it appears on the card
Cardholder’s Signature: (please sign for validation)
To make a one time gift only, please see other side
r I understand that I can cancel my monthly gift at any time simply by contacting SMBH, and that I will
be issued one tax receipt at the end of each year, for the sum of all my monthly gifts.
SMBH depends on individual generosity to provide seniors the resources they need to
live a long, full life. Currently SMBH does not exchange mailing lists with other charitable
organizations; however, it may do so in the future. If you would prefer that your name is not
available, please check this box. r
Charitable Number: 10803 1295 RR 0001
Tax receipts are issued for gifts of $10 or more.
St. Matthew’s Bracondale House
707 St. Clair Ave. West
Toronto, Ontario M6C 4A1 Tel: 416.656.2669
www.smbh.ca Email: hazelton@smbh.ca Fax: 416.656.8052
3 Yes, I will become a monthly donor, and provide seniors with the
community support they need all year round!
Step 1: Select a gift size
r $10 r $15 r $20 r $30 r Other (Please Specify) $_______
Step 2: Select a payment option
r Cheque (Enclose a blank cheque markedVOID)
r Credit Card
r Visa
r MasterCard
Card#
Expiry Date
Name as it appears on the card
Cardholder’s Signature: (please sign for validation)
To make a one time gift only, please see other side
r I understand that I can cancel my monthly gift at any time simply by contacting SMBH, and that I will
be issued one tax receipt at the end of each year, for the sum of all my monthly gifts.
SMBH depends on individual generosity to provide seniors the resources they need to
live a long, full life. Currently SMBH does not exchange mailing lists with other charitable
organizations; however, it may do so in the future. If you would prefer that your name is not
available, please check this box. r
Charitable Number: 10803 1295 RR 0001
Tax receipts are issued for gifts of $10 or more.