General Giving Form - Gillette Children's Specialty Healthcare

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Gift Notification Options

Gift Details

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$500.00

$250.00

$100.00

$50.00

$25.00

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Gift type:

One-time gift

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Additional Comments

Tribute Gift

Honor Gift Type:

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Yes, Send an eCard Yes, I would like to send an eCard.

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Recipient email addresses:

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eCard Subject:

eCard Message:

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Payment Information

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Credit CardBank Account Withdrawal

Credit Card Information:

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Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

Checking Account Information:

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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 each month to fulfill my donation commitment. If I choose to make any changes to my donation, I will provide Gillette Children's Foundation 14 days advance notice. A record of each payment will appear on my monthly bank statement and will serve as my receipt. Please agree to these terms to continue.

Check Information

Billing Information

First Name:

Last Name:

Street 1:

Street 2:

City:

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If you donate and have not already registered, you will receive periodic updates and communications from Gillette Children's Specialty Healthcare.