General Donations and Gifts
Use this secure online form to provide a donation to Susquehanna Health Foundation.
If you prefer, you can
download
the donation form and send your gift in the mail.
Personal Information
Name
Address
City
State
Zip
Home Phone
Business Phone
Email
This Gift Is:
In Memory Of
In Honor Of
Name
Address
City
State
Zip
Gift Information
I would like to make a gift of $
I would like to make a pledge. Please contact me.
Make my gift avaliable to support the hospitals' greatest need/Project 2012.
Please direct my gift to be used by the following program or department:
Gift Payment Options
Visa
Mastercard
Name on Card
Card Number
Expiration Date
Month
Year
Please recognize me as an anonymous donor.
Please notify the following of my gift
Name
Address
City
State
Zip
I have a matching gift form. Please contact me.
I have remembered Susquehanna Health Foundation in my estate plans.
Please contact me about the following:
planned gifts
stock gifts
Comments
I understand that by submitting this form, I am authorizing Susquehanna Health Foundation to charge my credit card for the amount I specified above. Your gift is tax deductible to the fullest extent allowed by law. If you have any questions, please call the Foundation Office at 570-320-7460. An acknowledgement will be sent to you in the mail for tax purposes.