EQUIPMENT FOR INDEPENDENCE

Field Is Required Enter A Gift Amount:

$10,000.00

$5,000.00

$2,500.00

$1,000.00

$500.00

$100.00

Other Amount:

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Yes, automatically repeat this gift every month.

This gift is in honor, memory, or celebration of someone

Honor Gift Type:

Honoree Title:

Honoree Name:

Notification Recipient Title:

Notification Recipient Name:

Notification Recipient Street 1:

Notification Recipient Street 2:

Notification Recipient City:

Notification Recipient State:

Notification Recipient ZIP/Postal Code:

Message Body:

Does your employer have a matching gift program? Search for their name below! If they do, you will receive the information needed to complete your matching gift request on the confirmation page you see after submitting your donation to Craig.

Billing Information

IF THIS IS A CORPORATE/ORGANIZATION GIFT, PLEASE ENTER NAME HERE:

First Name:

Last Name:

Street 1:

Street 2:

City:

State/Province:

ZIP/Postal Code:

Email Address:

Phone Number:

Yes, I'd like to receive email updates from this organization.

Payment Information

Payment Method:

Credit CardBank Account Withdrawal

Credit Card Information:

Credit Card Type:

Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

Checking Account Information:

Bank Routing Number: What is this?

Bank Account Number:

Verify Bank Account Number:

Account Type:

Checking
Savings

By checking this option, I agree to use my bank account as a payment method and authorize this organization to debit my bank account to fulfill my donation commitment.

Craig Hospital Foundation

EQUIPMENT FOR INDEPENDENCE

Billing Information