Thank you for helping St. Ann's provide the highest quality care to our Residents, patients and program participants. Please complete the form below and click on the button at the bottom for a printer-friendly form. When finished, either fax or mail your Gift Form to the number or address below:
On behalf of those who will benefit from your generosity, thank you for your support of St. Ann's Community. If you have any questions, please contact the Foundation Office at (585) 697-6321.
Please make checks payable to St. Ann's Foundation or complete the credit card section of this form. An acknowledgment and tax receipt will be sent to you within 48 hours of receipt of your contribution.
Date:
Enclosed is my gift of:
Name as you wish to be listed in publications
"I wish to remain to be anonymous"
First Name: Last Name:
Address:
City:
State: Zip :
Telephone Number: Email:
Amount To Charge: Type of Card: Visa Mastercard
Card #: Expiration Date:
Name on Card:
Signature: ________________________________________________ (to be completed after printing form)
If you would like to include your gift in our Tribute program, please complete this section.
I would like this gift to be made "In Honor Of" "In Memory Of"
Name:
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