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General Donations and Gifts

Use this secure online form to make a donation to Susquehanna Health Foundation.
To make a pledge or to donate by check, you can download the donation form and send your gift in the mail.

Personal Information:

* Name:
*Address:
* City:
* State:
* Zip:
* Home Phone:
Business Phone:
* E-mail:

This Gift Is:

Gift Information:

* I would like to make a:

* I would like to make a gift of $
* I hereby authorize the Susquehanna Health Foundation to withdraw:



($5 minimum)

on the of each month starting in /

Please direct my donation to:

Please contact me about the following:

Comments:

Payment Options:

I would like to pay with:
Accepted Cards:

Pay By Credit / Debit Card:

* Name on Card:
* Card Number:
* Expiration Date:
* CVV Code: (3-4 digit code on the back of card)

I understand that by submitting this form, I am authorizing Susquehanna Health Foundation to charge the payment information above for the amount I specified. Your gift is tax-deductible to the fullest extent allowed by law. If you have any questions, please call . An acknowledgement will be sent to you in the mail for tax purposes.