Plaque

110 King St, Oakville ON L6J B1 905-844-2695
Plaque Order and Payment Form
a new plaque.a replacement plaque.
Name*

First NameLast Name
Phone *
Format: 000 000-0000.
E-mail*
Plaque Address*

Street Address

Street Address Line 2

City Province

Type in Postal Code
Billing Address if different than Plaque Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Comments
Plaque Payment*
Donation
Tax receipt provided for annual accumulated donations of $20.00 or more
Total
Total Due

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CADDescription
e-Transfer to ohs.payment@gmail.comCredit Card, VISA Debit Card, or PayPal
Version

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty: