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William Newton Hospital

WNH Foundation Online Donation

Please complete the contribution form below. WNHF respects and is committed to protecting your privacy. All information will be kept secure and confidential at all times. For more information regarding your online gift or online privacy, please do not hesitate to contact the Foundation.

We appreciate your support and hope that you consider your gift an investment in the future of healthcare within our community.
* Last Name
Last name as it is listed on credit card
* First Name
First name as it is listed on credit card
  E-Mail Address
Complete this field if you would like to receive correspondence from WNHF via email.
* I wish my gift to benefit the following fund:
If you select more than one fund, your gift will be evenly distributed amongst your selections. If you would prefer to designate the amount given to each fund, please provide detailed instructions in the message box below.
Physician Recruitment
Building & Facility
Equipment
Scholarships
Endowment
Area of Greatest Need
  My gift is in honor of:
Please type in first and last name.
  Who should receive the acknowledgement?
If you would like an acknowledgement to be sent, please provide us with the name and mailing address of the intended recipient in the box. If the honoree is a William Newton Hospital or Rural Health Clinic employee, please provide the department or clinic name where that individual works.
  My gift is in memory of:
Please type in first and last name.
  Who should receive the acknowledgement?
If you would like an acknowledgement to be sent, please provide us with the name and mailing address of the intended recipient.
  Messages or comments?
* Note
By checking this box, payer acknowledges agreement with the privacy and security statements listed under the tab at the top of this page.
Donation Details
* 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