Circle of Caring Sponsor Form - Hospice of Southern Maine

CIRCLE OF CARING

Cocktail Reception

Sponsorship Level

Select a Level:

Circle Sponsor

$ 1,000.00

Corporate Sponsor

$ 500.00

Other

$

*

Additional Information

Corporate:

This donation is on behalf of a company

Anonymous:

I prefer to make this donation anonymously

Comments:

Tax Receipt Preference:

*

Billing Information

Title:

First name:

*

Last name:

*

Country:

*

Address lines:

*

City:

*

State:

*

ZIP:

*

Phone:

*

Email:

*

Payment Information

Cardholder's Name:

*

Credit Card Number:

*

Card Type:

*

Card Expiration:

/

*

Card Security Code:

help

*