Donation Form

We deeply appreciate your thoughtful support.

Please contact us for further information or questions (432) 682-2855.

Donation Details

Amount

Type of Donation

One Time DonationRecurring Donation

Please Select Designation

I would like to dedicate this donation

Donor Information

First Name

Last Name

Address

City

State/Province

Zip/Postal Code

Home Phone

Work Phone

Spouse Name

Help Us Cover Costs

Simply leave "Yes!" checked below to ensure that 100% of your intended donation is available for our mission.

Yes! I want $0.00 to go to Hospice of Midland, Inc. and I will donate $0.00.No. I will donate $0.00 and Hospice of Midland, Inc. will cover the processing costs.

Payment Information

Payment Options

Credit Card Information

Card Holder Name

Card Account Number

Expiration Date

Security Code

Billing Address

Same As Above

Address

City

State/Province

Zip/Postal Code

Hospice Midland is a non-profit 501(c)3 organization.
Your contribution is tax deductible to the extent allowed by law.
A tax receipt will be mailed to you.

Privacy Policy
We keep your personal information private and secure. When you make a payment through our site,
you provide your name, contact information, payment information, and additional information related to your transaction. We use this information to process your payment and to ensure your payment is correctly credited to your account.