†Delta Health Foundation, Inc. Donation Form
Here is my gift of:
____$25 ____$50 ____$100 ____$500 ____$1,000 ____Other $_________
State_______________ Zip _____________
Charge my credit card: _____ MasterCard _____ Visa _____ American Express
Is this a company credit card? _____ yes _____ no
If yes, company name_________________________________________________________
Name as shown Card_________________________________________________________
If paying by check, please make your check payable to Delta Health Foundation, Inc.
Please fill out this form and mail, with donation, to:
Delta Health Foundation, Inc.
7401 Delta Lane
Charlotte, NC 28215
Delta Health Foundation is a 501(C)(3) charitable organization. Contributions to Delta Health Foundation are tax deductible to the full extent allowed by law. To control expenses, the Foundation will send receipts for gifts of $25.00 or more.
___My employer has a matching gift program; please send me information on how to double my gift.
___Iím interested in automatic monthly, quarterly or semi-annual giving; please send me more information.