St. Mary Foundation Online Gift Form

Thank you for supporting St. Mary Medical Center. Please complete the below information to make your gift online. If you have any questions or would like further guidance on gift options, please contact the Foundation staff at 215-710-2591 or foundation@stmaryhealthcare.org.

Donation Information

Amount:

$1,000.00

$500.00

$250.00

$100.00

Other

$

*

Designation:

Additional Information

Type of gift:

One-time gift
Recurring gift

Corporate:

This donation is on behalf of a company

Anonymous:

I prefer to make this donation anonymously

Comments:

Spouse/Partner:

I would like to provide information about my spouse/partner

Billing Information

Title:

*

First name:

*

Middle name:

Last name:

*

Country:

*

Address:

*

City:

*

State:

*

ZIP:

*

Phone:

Email:

*

Confirm Email:

*

Payment Information

Payment Method:

Credit CardPledge

Cardholder's Name:

*

Credit Card Number:

*

Card Type:

*

Card Expiration:

/

*

Card Security Code:

*

Matching Gifts

My company will match my gift

Tribute Information

First name:

Last name:

*

Type:

*

Description:

*

Mail a letter on my behalf to

*

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