ONLINE DONATION FORM!!!!!!

Doctors Community Hospital Foundation is a 501(c)(3) organization under the Internal Revenue Service tax code. Gifts are tax-deductible as charitable donations to the fullest extent allowed by law.

Please know that your personal data will be sent securely, and all information is confidential.

 

Donation Information
Amount:	$ 1,000.00 $ 500.00 $ 250.00 $ 100.00 Other $     *
Designation:	General Fund Breast Friendraiser Cancer Services Diabetes Care Center Emergency Center Surgical Services Women's Health Center Other
Other	*
Additional Information
Type of gift:	One-time gift Recurring gift Pledge (installments)
Frequency:	Weekly Monthly Quarterly Annually On:   Sunday Monday Tuesday Wednesday Thursday Friday Saturday Starting:    Ending:   Ending:
Corporate:	This donation is on behalf of a company
Anonymous:	I prefer to make this donation anonymously
Comments:
Billing Information
Title:	Mr. Mrs. Ms. Dr. Miss Mr. & Mrs. The Honorable Chief Admiral Ambassador Brother Capt. Cmdr. Col. Delegate Drs. Father General Governor Judge Lt. Madam Major Pastor President Prof. Rabbi Reverend Secretary Senator Sir Sir/Madam Sister Reverened The Officer Senior Vice President III Lt. Gov. Honorable Lt. Col. Deacon Dea. CEO Mayor Miss. Co-Pastor Councilmember Bishop Elder Dr. & Mrs. Dr. & Mr. Mr. and Mrs. Dr. and Mrs. Lt. General Mr. and Dr. Dept. Chief Sgt. County Executive Colonel Principal
First name:		*
Middle name:
Last name:		*
Country:	United States	*
Address lines:		*
City:		*
State:	<Please Select> MD VA DC AA AB AE AK AL AP AR AS AZ BC CA CO CT CZ DE FL FM GA GU HI IA ID IL IN KS KY LA MA MB ME MH MI MN MO MP MS MT NB NC ND NE NL NH NJ NM NS NT NU NV NY OH OK ON OR PA PE PR PW QC RI SC SD SK TN TX UT VI VT WA WI WV WY YT	*
ZIP:		*
Phone:
Email:		*
Payment Information
Payment Method:	Credit CardDirect Debit
Cardholder's Name:		*
Credit Card Number:		*
Card Type:	Visa American Express Discover MasterCard	*
Card Expiration:	01 02 03 04 05 06 07 08 09 10 11 12  / 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039	*
Card Security Code:		*
Tribute Information
Type:	In Honor of In Memory of	*
Name:		*
First name:
Last name:		*
	Mail a letter on my behalf to	*