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CC Medical Foundation
The Calhoun County Medical Foundation was created for the express purpose of soliciting funds to support the capital expense needs of the Memorial Medical Center. We are a non-profit organization.
You may donate by providing your credit card information in below fields. All payments are via secure server. Thank you for your support.
*	Name As It Appears On Donor's Credit Card or Checking Account
*	Amount of Your Donation Please Specify the Amount of Your Donation	$
	Acknowledgment Please send an acknowledgement card in my/our name to:
	Street Address
	City
	State
	Zip Code
	Personal Message Personal Message included with Acknowledgment:
*	Cardholder First Name The first name of the account holder as it appears on the credit card.
*	Cardholder Last Name The last name of the account holder as it appears on the credit card.
*	Amount of Payment Format: 45.67 (Include decimal and cents. Do not use a dollar sign.)	$
*	Card Number
*	Expiration Date	12345678910111220242025202620272028202920302031203220332034
*	Card Code Verification Number The three digit number on the back of your card. (Four digit code on the front of American Express.)
*	Billing Postal or Street Address
*	Billing City
*	Billing State	AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
*	Billing Zip Code 5 digit zip code