Donate Online | OakBend Medical Center

Please fill out the form below to make an online credit card donation to Oakbend Medical Center. Fields with an asterisk (*) are required in order to process your transaction. If you wish to pay by check, please complete our Mail-In Donation form and mail it in along with your check made payable to Oakbend Medical Center.

This gift is from....
Individual
Corporation

Is this a joint donation with: *
Spouse
Other
Not a Joint Donation

If this is a joint donation. Please identify the name(s) of joint donor(s) (e.g. Mrs. Sally Smith; the Smith family; The Employees of ABC Corporation, etc.).

*Email Address:

*Daytime Phone Number:

*Address 1:

Address 2:

*City:

State:

*ZIP code:

*Country:

Please Use My Gift For...*
Annual Fund (use my gift where it is most needed)
Patient Care
Education
Prevention
Research (general)
Specific fund or program, specify below (e.g., lung cancer research)
Research (other)

I Would Like To Contribute...
$250.00
$100.00
$50.00
$25.00

Other: $

My Credit Card Information...*

*Credit Card Type:

*Card:

*Card Security Code CVV:

*Expiration Date (mm/yy):

-

Billing Address 1:

Billing Address 2:

Billing ZIP code:

*Name as it appears on card:

Please Inform Me If My Company (Or My Spouse's Company) Has A Matching Gift Program...

*Company Name:

*Company Name (spouse):

Confirm Identity

*For security purposes, please enter the code you see below:

Please allow 3 to 5 business days for processing of your gift.

Thank you.