Donate | Henry County Hospital Foundation

Road Construction Detour Map

1600 East Riverview Ave., Napoleon, OH 43545 ・ 419.592.4015

1

Amount

2

Name

3

Payment

Donation Amount

- $500
- $250
- $100
- $50
- $25
- Other
Other Amount
Make this a monthly donation.

In Support of
Dedicate this gift
Make this donation
His or Her Name
Please send an acknowledgement to:
(without specifying amounts, honorees will receive notification that a gift has been made in their name)
Name
Address
City
State
Zip Code

Contact Information

First Name
Last Name
Email
For recognition purposes, how would you like your name(s) to appear?
I would like my gift to be anonymous
Billing Address
Billing Address 2
City
State
Zip Code
Phone Number

Billing Information

Name On Card
Card Type
Card Number
Security Code
Expiration Date
/
Comments

Donate

For assistance, or to make a gift by phone, please contact the Fund Development Office at (419) 592-4015