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Donations via credit card
Name
*
First name
Last name
Address
For receipting please
Address line 1
Address line 2
Address line 3
Address line 4
Town/Suburb
City
Postcode/Zip
Email address
Home phone
Cell phone
Amount $
*
$50.00
$100.00
$500.00
Other amount
$
If your donation is made in memory of someone special please let us know.
Donation Method
Hospice South Canterbury CCard
Please check the highlighted fields
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