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Donation FAQ
* Bolded fields are required.
Personal Information
First Name
Last Name
Address
City
State / Zip
Day Phone Number
-
-
Evening Phone Number
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-
E-mail Address
the e-mail address you specify will only be used for this purpose
Donation Information
Use of Gift
Where Needed
For:
If gift is given as a
memorial or honorarium
In Memory Of:
In Honor Of:
Payment Information
Your gift is tax deductible as provided by law.
Amount
$
Payment Method
Credit Card
Checking/Savings Account
Card Type
select card type »
Visa
MasterCard
Discover
Additional credit card information will be requested on the next screen.
Account Type
select account type »
Checking
Savings
Financial Institution and Branch
Financial Institution City
Financial Institution State/Zip
Account Holder's Name
Account Holder's Address
Account Holder's City
Account Holder's State/Zip
Routing Number
How can I find?
Account Number
How can I find?
Notification
Please notify the following individual of my gift.
(The amount of your gift will remain confidential.)
Name:
Address:
City:
State / Zip:
Your relationship
to person:
Other Information
Please send me more information about:
Including HRMC Foundation in my will
Planned giving
Volunteering
To help us ensure this is a valid donation,
please type the numbers displayed:
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