Downloadable Donation Form - Pardee Hospital
Downloadable Donation Form - Pardee Hospital
Downloadable Donation Form - Pardee Hospital
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<strong>Donation</strong> <strong>Form</strong>Name: _______________________________________(print or type)_______________________________________(signature)Company: _____________________________________________________________________________Address: ______________________________________________________________________________City/State/Zip: _________________________________________________________________________Phone: _____________________________Email: __________________________________________I would like to make a gift to <strong>Pardee</strong> <strong>Hospital</strong> Foundation for:Unrestricted Gifts (used to meet the greatest needs of the hospital):☐ Generations of Excellence ($1,000 +)• Pacesetters ($10,000 +)• Benefactors ($5,000 - $9,999)• Sustainers ($1,000 - $4,999)☐ The Annual Fund Giving Societies ($1 - $999)• Founders’ Circle ($500 - $999)• President’s Club ($250 - $499)• Friends of <strong>Pardee</strong> ($100 - $249)Restricted Gifts:☐ Endowment (circle one)o Generalo Women’s Initiatives☐ Events (circle one)o Tournament of Championso Diamond Jubilee Galao Women Helping Women
☐ Centers of ExcellenceClinical Area: ________________________________________________☐ Other: _________________________________________________________☐ I wish to make a gift of $_______________________________________________________________☐ in memory of: _________________________________________________________________☐ in honor of: ___________________________________________________________________☐ I would like to make a gift to honor a physician or staff member:Name of honoree: _________________________________________________________________Payment Information:☐ I am enclosing a check for $________________________ made payable to <strong>Pardee</strong> <strong>Hospital</strong> Foundation.☐ Please charge $______________________________ to my Visa, MasterCard, or Discover Card.Credit Card #: ___________________________________________ Expiration Date: ________________Name on Card: ___________________________________________Credit Card Billing Address (if different from above):Address: ________________________________________________________________________City/State/Zip: ___________________________________________________________________Additional Information:☐ I / We wish to remain anonymous.☐ Please send me information about making an estate gift to <strong>Pardee</strong> <strong>Hospital</strong> Foundation.☐ I have already made a planned gift to <strong>Pardee</strong> <strong>Hospital</strong> Foundation in the form of: ______________________________________________________________________________________________________☐ Please send me any information brochures that would help me get better acquainted with theFoundation.☐ Please contact me about the possibility of a tour of the hospital.Please send to:For more information, contact:
<strong>Pardee</strong> <strong>Hospital</strong> Foundation Phone: 828-696-4666800 North Justice Street Email: pardee.foundation@pardeehospital.orgHendersonville, NC 28791Email: pardee.foundation@pardeehospital.org
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