Home Hospice Care Campaign Donation Form - Hospice of Southern Maine

Make a difference today

Your gift will support our new, state-of-the-art Home Hospice Center so that we may better serve the growing number of patients who wish to die at home. Gifts of $1,000 and above will be recognized as members of the Circle of Caring, and your name will be included on the donor wall of the new Home Hospice Center. For gifts of $10,000 and above, please call (207) 289-3658 if you are interested in a naming opportunity.

Click here to download a Home Hospice Care Campaign pledge form.

Step 1

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Gift Details

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Gift Info

Gift Type

One-Time

Recurring

Pledge

Gift Amount

$500

$1,000

$2,500

$5,000

$10,000

Starting *

Your first payment will be taken on the 1st or 15th of the month closest to the date you select

Frequency

Monthly

Number of installments*

Installment amount

Starting *

Pay pledge on *

Your first payment is today, unless you specify a different start date. Then select the frequency for future payments.

Frequency

Monthly

Quarterly

Semi-Annually

Annually

Ending

Gift Details

This gift is in memory or in honor of somebody

Name *

First Name

Last Name *

Type *

Mail a letter on my behalf (to)

Full Name *

First Name

Last Name *

Phone

This gift is made on behalf of a company or organization

I prefer to make this donation anonymously

My company will match my gift

Comments

Personal Info

390 US Route One, Scarborough, ME 04074 | (207) 289-3640 | give@hospiceofsouthernmaine.org | Privacy