Secure Payment Form
I (We) would like to support the Foundation's Annual Campaign with a tax deductible contribution at the level checked below.
Gifts of $200 or more will be recognized on a display board in the hospital lobby.
List gift as from:
Name(s), Title if used, Company, Other
This contribution is to be used:
Where need is greatest
Contributions must be received by December 31st.
Donor First Name
Donor Last Name
Credit Card Information
Name as on Card
Card Billing Address
Card Billing Zip
Card Expiration Date
For information, please call 716.793.2338 or 716.793.2315. Thank you!