SECURE ONLINE GIFT FORM (SSL Secure)

This Online Form is SSL Secure

This form is designed for you to make gifts electronically via credit card to any hospital, service or fund that is part of Cone Health. Thank you for your support.

If you have questions or need assistance making a gift, please call 336.832.9450 during business hours or send an email to fund.development@conehealth.com.

Items marked bold are required fields.

Gift Amount
Yes, I/we want to Help Create Exceptional Care by making a gift of:
$1,000
$500
$250
$100
$50
$25
Other: $

Gift Designations
Please designate this to:
Area of Greatest Need
Cancer Center
Cancer Center Expansion (Making Room for Hope)
Great Beginnings Fund
Heart and Vascular Center
LeBauer Cardiovascular Research
Neurosciences, Stroke and Rehabilitation
Nursing
Palliative Care
Pastoral Care
Pediatrics
Women's Only/Mammography Fund
The Moses H. Cone Memorial Hospital
Wesley Long Hospital
Women's Hospital
Annie Penn Hospital
Other
Other:

Honors and Memorials
I/We would like to dedicate this gift: In Memory ofIn Honor of
Honoree's name:
For the following occasion:
Please Notify:
Name:
Street Address:
City:
State:
Postal Code:
Country:

Donor Information
Preferred Title:
First Name:
Middle Initial:
Last Name:

Spouse/Partner Information (if applicable)
Preferred Title:
First Name:
Middle Initial:
Last Name:

Enter address, city, state and postal code
as filed with your financial institution.
Address Type: Home   Business
Street Address:
City:
State:
Postal Code:
Country:
Email Address:
Daytime Phone:

Recognition Preference
Please list my (our) name in donor recognition materials as:
I would like my gift to remain anonymous.

Credit Card Information
Amount: $
Name on Card:
Card Type:
Card Number:   (No Dashes or Spaces)
CVV2: Click here for CVV2 information.
Expiration Date: mm/yyyy

Matching Gift Company
My company will match my gift.
Company Name:

Other Information
I/We have included Cone Health in my/our will, retirement plan, 401(k) or insurance policy.

I/We are interested in learning about other ways to Help Create Exceptional Care. Please contact me/us.

Comments

A formal acknowledgement letter will be mailed to you. Thank you for your gift.

Contributions to Cone Health are tax deductible to the extent permitted by law. We do not sell or trade our mailing lists.


Security

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Questions? Call the Office of Fund Development at 336-832-9450

Office of Fund Development
1200 N. Elm Street, Greensboro, NC 27401