[Your Organization] Donation Form

Online donation form for [Your Organization]

You can make a secure donation online using your credit card. Your gift to [Your Foundation] will support patient and family care, community outreach, and our grief and loss and bereavement programs.

Please begin by telling us about yourself and the type of donation you would like to make. Then click on the "Process your donation" button below to enter your credit card information via PayPal.

Amount:

Donor Information: Donor's Name: Ms. Mrs. Mr. Dr. (none)
First: Last: M.I.
For recognition: No recognition (Please make this an anonymous donation) Please recognize the following: Donor, as listed above An organization: Other:
Email:
Address:
City:
State:
Zip Code:
Phone:

Where would you like your donation applied? Patient Care – Supports: direct assistance for local hospices Bereavement – services for bereaved locals Camp Dragonfly – a delightful summer camp for youth Capital Campaign – building capital funds for our growth Volunteer Programming – materials and resources for our volunteers Other

Honor / Memorial Information: This gift is given: In memory of In honor of Name:
Please notify the following person(s) of this gift:
Ms. Mrs. Mr. Dr. (none)
First: Last: M.I.
Address:
City:
State:
Zip Code:

Ms. Mrs. Mr. Dr. (none)
First: Last: M.I.
Address:
City:
State:
Zip Code:


[Your Organization] gratefully thanks you for your kindness and compassion. A copy of the registration and financial information of [Your Foundation] (Tax ID #[Your Tax ID]) may be obtained from the . Click on the button below to enter your financial information within the added protection of PayPal's secure server.
For questions or if you are experiencing any problems with this page, please contact: [Your Organization] Development Department [Your Phone Number] or [Your Email Address] Address: [Your Address]