Make a Tribute Gift - Anna Jaques Community Health Foundation

Keep Our Community Healthy

Give a Tribute Gift

Mission Photo- Dennis.jpg

Many donors wish to honor the memory of friends or loved ones by making a gift to Anna Jaques Hospital in their name, or on the occasion of a special event, such as a birthday or anniversary. It’s the perfect way to support the hospital and honor someone special in your life. To make a tax-deductible tribute gift right now, please fill out and submit the form below.

* = Required fields

Gift Information

Field Is Required Enter A Gift Amount:

$100.00

$50.00

$35.00

Enter an Amount

Enter amount

Yes, automatically repeat this gift every year on this date.

Gift Designation

Field Is Required Enter a Gift Designation:

Use my gift where it is needed most.

Direct my gift to:

If you selected other designation, please enter the purpose of your gift:

Honoree Information

Honor Gift Type:

Honoree Name:

Notification Recipient Name:

Notification Recipient Street 1:

Notification Recipient Street 2:

Notification Recipient City:

Notification Recipient State/Province:

Notification Recipient ZIP/Postal Code:

Comments:

Payment Information

Credit Card Information:

Credit Card Type:

Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

Billing Information

Make this gift on behalf of an organization

Organization Name:

First Name:

Last Name:

Billing Street 1:

Billing Street 2:

Billing City:

Billing State:

Billing ZIP:

Email Address:

Yes, I would like to make this donation anonymously

Yes, I would like to receive communication from this organization.