Make a Gift

Loading...

How much would you like to donate to Evangelical Community Hospital?

Amount
$

Would you like to give your gift in honor or in memory of someone?

Yes No

If you would like to make a gift to support Evangelical Community Hospital, you can do so online by completing the form below. Or, if you prefer, you can download our printable donation form and send it by mail along with your gift.

This Gift is

Please Notify Someone About This Gift

Name:
Address:
City:
State:
Zip:
I have a form stating that my company will match my gift. Please contact me.

I have included Evangelical Community Hospital in my estate plans.

Please select one:

Please make my gift available to support any Evangelical Community Hospital program and/or service.

I would like my gift to be used for the program, service, or department I have indicated in the comments/special instructions below.
Comments /Special Instructions:

Back Next

Personal Information

Name:
Address:
City:
State:
Zip Code:
Home Phone:
Cell Phone:
(optional)
Email:

Back Next

Billing Information

Same as my Personal Information
Address:
Additional Address:
City:
State:
Zip Code:

Payment Information

Name (as it appears on card):
Card Type:
Credit Card Number:
CVV:
What is my CVV code?
Expiration Date:
Please carefully review all information—your card will be charged once you click Submit.

It is the Hospital’s policy that gifts are non-refundable. For more information, contact the Development Office at 570-522-2685.

Back

Donation Information

Edit