Commission Donation form

Yes! I want to join the Royal LePage® Shelter Foundation™ as a Commission Donor to help women and children safely escape intimate partner violence.

Questions? Please contact us at shelterfoundation@royallepage.ca

Charitable registration number: 882531304 RR0001

I would like to donate the following from each transaction end (please check one)*

A$25 per end

B$35 per end

C$50 per end

D$100 per end

EOther amount per end

You choose where your donation dollars are directed*

A50% of my gift will support my local women's shelter and 50% will support intimate partner violence prevention programs across Canada and emerging needs in the sector.

B100% of my gift will support my local women's shelter.

First name*

Last name*

Email address*

My Royal LePage® brokerage*

My administrator's name (if known)

My administrator's email address (if known)

My preferred language*

AEnglish

BFrench

Please issue my tax receipt using:*

AMy personal name

BMy business's name

Today's date*

May we publicize your support?*

AYes, I agree to have my name published.

BNo, I do not agree to have my name published.

I understand and agree that I may cancel my commitment at any time by advising my office administrator and that, in so doing, I will cease all advertising associated with the Royal LePage Shelter Foundation Commission Donor program. *

AYes

I understand that the Royal LePage Shelter Foundation issues tax receipts in late February for donations made in the previous calendar year.*

AYes

Please provide your signature, signifying consent for your brokerage to send the donation amount noted above to the Royal LePage Shelter Foundation.*

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