Your browser does not support JavaScript!
This form cannot automatically check that you have submitted all of the required fields without JavaScript.
Please be sure to submit all required fields (marked with stars).

Perry County Memorial Hospital

Foundation Donations

Perry County Memorial Hospital welcomes online donations from members of our community. There are various needs and programs that continually need support and funding. Please accept our thanks for your consideration and donations. To donate please scroll down the page and read the short directions.
All information will be kept secure and confidential. For more information or to make a donation you may call our foundation office at 812-547-0153. We are a 501(c)3 non-profit organization.

We want you to know that Perry County Memorial Hospital Foundation carefully uses your donation for important needs of the hospital. You may donate by providing your credit card information in below fields. All payments are via secure server. Thank you for your support.
* Name
Exactly As It Appears On Donor's Credit Card.
* Your Email Address
Please Provide An E-mail Address.
* Donation Designation
If in honor of or in memory of an individual, please enter name below.
  Donation Acknowldgment
Please enter the name and address of the individual to whom we should send an acknowledgment.
  Comments or Messages Related To Your Donation
* Amount of Payment
Format: 45.67 (Include decimal and cents. Do not use a dollar sign.)
* Card Number
* Expiration Date
* 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
* Billing Zip Code
5 digit zip code