AMBULANCE SERVICES


ANNUAL FUND
Support annual operating costs including charity care

ENDOWMENT SECURE OUR FUTURE

EXTENDED CARE

HOSPITAL IMPROVEMENT FUND
Help support all the little extras that are needed to make our Hospital and Extended Care the best:
Landscaping, furnishings, exterior

MEDICAL EQUIPMENT FUND

RURAL HEALTH CLINIC

WELLNESS CENTER

Tribute Information (Optional)

Name:

Relationship:

Type In memory of In honor of

Acknowledgement Letter Yes No

Address:

City: State: Zip Code:

Donor Information

Donor's Name: A value is required.

Amount: A value is required.

Billing Address: A value is required.

City: A value is required. State: A value is required.Zip Code: A value is required.

Phone Number: Example 4062713211

Email Address:

Visa

Master Card

American Express

Discover

Card Holders Name: A value is required..

Card Number: A value is required.

Credit Card Expiration (mm/yy): A value is required.

CCV: A value is required. A value is required.Example

Notes for the donation:

Please make a selection.You must accept to make a payment. I authorize Pondera Medical Center to bill my credit card for the above amount.