Fall Appeal 2022 Donation Form - Hospice of Southern Maine

Your support helps create meaningful, one-of-a-kind experiences for our patients and families.

Click here to read Becky's story.

Donation Information

Amount:

Circle of Caring Member

$ 1,000.00

$ 500.00

$ 250.00

$ 100.00

$ 65.00

$ 50.00

Other

$

*

Designation:

Additional Information

Type of gift:

One-time gift
Recurring gift

Frequency:

On:
Starting: Ending:

Corporate:

This donation is on behalf of a company

Anonymous:

I prefer to make this donation anonymously

Comments:

List me in the Annual Report as:

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

*

Matching Gifts

My company will match my gift

Company:

*

Tribute Information

Type:

*

Name:

*

First name:

Last name:

*

Mail a letter on my behalf

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