The Heart Institute: Donations

Heart Institute of the Cascades Credit Card Donation Form
Thank you for supporting the fight against cardiovascular disease. Please complete the secure form below to make a credit card donation. You will be able to review your information before submission for processing payment. Your privacy will be respected and no information will be shared with third parties. For a mail-in or faxable donation form click here. *Indicates required information

Gift Information
*The amount of my tax-deductible gift is $:
Please apply my gift to the fund:

*Cardholder First Name:
*Cardholder Last Name:
*Address Line 1:
Address Line 2:
*City
*State/Province:
*Zip/Postal Code:
*Country:
Telephone Number:
Fax Number:
*Email Address:

Gift Options
Person(s)/Company Gift is From:
This Gift is (check if appropriate)
In Memory of In Honor of
Name:

Please Notify Person(s) Named Below:
Name:
Address Line 1:
Address Line 2:
City:
State/Province:
Zip/Postal Code:
Country:

Comments/Questions/Instructions:




For additional information, please contact the Heart Institute of the Cascades at 541-385-6357.

Donation Form