Fields marked * require an entry.

Monthly donation

It's easy to set up an automatic recurring gift to the Salem Health Foundation!

Please complete the following information and you're done.

Be sure to let us know how you would like your donation used; whether it's for the Cancer Fund or Heart Fund, or maybe Where Need is Greatest, your gift will help us improve the health and well-being of the communities we serve.

Donation Form

My monthly donation will be:

I want my gift to be used for:*

I would like my donation to recur:

Yes

Amount you would like to recur:

Frequency of donation:

Number of recurrences:

Date of your final recurring donation:

Open the calendar popup.

Please confirm recurring donation:

This is a joint gift from myself and:

If you selected "Other" please indicate how you would like your gift to be used?

Contact Information

Company:

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country / Location:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Email:*

Credit Card Information

Card Types Accepted:
Visa

Credit Card Number:*

Card Security Code:*

Expiration Date:*

Electronic Signature:*

I agree to pay above total amount according to card issuer agreement. Once the transaction has completed successfully, a confirmation receipt will be sent to the email address entered.