Northeast Health Foundation Secure Online Donation Form

Northeast Health Foundation Secure Online Donation Form

Northeast Health Foundation Donation Form

Contributions to Northeast Health Foundation, a tax exempt organization under section 501(c)(3) of the Internal Revenue Code, are deductible for calculating income and estate taxes as allowed by law.

PLEASE COMPLETE THE FOLLOWING INFORMATION:

I want to make a contribution (in U.S. currency) of:
                    $
Please select an affiliate:
Please use my gift where most needed or for the following purpose:
Albany Memorial Hospital       Beechwood - An Eddy Retirement Community       Beverwyck      
The Eddy       Eddy Alzheimer's Center at Hawthorne Ridge       Eddy Alzheimer's Services      
Eddy Heritage House Nursing Center       Eddy SeniorCare       Eddy Village Green      
Eddy Visiting Nurse Association       The Glen at Hiland Meadows       Glen Eddy      
Hawthorne Ridge       James A. Eddy Memorial Geriatric Center       The Marjorie Doyle Rockwell Center      
Northeast Health       Northeast Health Foundation       Our Lady of Mercy Life Center      
Samaritan Child Care Center       Samaritan Hospital       Schuyler Ridge      
St. Peter's Nursing and Rehab Center      
Other/Please use my gift for:
  
I wish to have my donation designated
         
We would like to notify the family who this gift is in memory/honor of, please fill in the appropriate information:
Name:
Address:
City, State, Zip
Comments:
Payment Method
Credit Card:
Visa       Mastercard       Discover       American Express      
Name on Card:
Card Number:
Expiration Date: Month (MM)  Year (YY) 
Cardholder Billing Address
First Name:
Last Name:
E-Mail:
Address:
 
Day Telephone:
Evening Telephone:
Special instructions/comments (if any):
St. Peter's Health Partners
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St. Peter's Health Partners
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