William Steinberg Election Fund donation form

First Name
Last Name
Address
Postal Code
Phone #
E-mail (very important)
Yes, I would like to make a donation
$140 (real cost $35) $100 (real cost $25) $ Please make cheques payable to William Steinberg Election Fund Note: For donations up to $140 you will get a provincial tax credit of 75% so you will get a refund of $105 for a $140 donation or $75 for a $100 donation.
Number of voters in your home including yourself
Please print this page and mail your cheque along with the completed form to: William Steinberg Election Fund, 7 Albion Road, Hampstead, QC H3X 3L8.