Online gift

Transaction

Appellation of the deceased person

First name of the deceased

Name of the deceased

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Personal information

E-mail

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Title

First name

Last name

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Province

Street no.

Street name

Street type

Apt. / office

City

Postal code

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TOTAL amount

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Comments (or information to be included in the card)

Organization's registration number:

10293 3827 RR0001

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