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Buena Vista Regional Medical Center

Donations By Credit/Debit Card

BVRMC greatly appreciates your generosity. All information will be kept secure and confidential. All payments are via secure server. Your gift to the Foundation is tax- deductible to the fullest extent of the law.

We want you to know that 100% of your donation goes to the support of BVRMC. You may donate by providing your credit/debit card information in the below fields.
* Name
As It Appears On Donor's Bank Account's Billing Statement.
* Billing Address
Address Where Your Card/Bank Statements are Mailed.
* City, State, Zip Code
Please Include Your City, State and Five Digit Zip Code.
  Your E-Mail Address
Please Provide An E-mail Address.
Memorial Or Honor: Please Share Name Of Person. Please Advise If You Would Like Us To Notify Person.
  Gift Information
Please Check If You Prefer To Be Anonymous, If Your Gift Is A Memorial Or In Honor Of Someone.
Anonymous     Memorial     In Honor Of    
Credit Card/Billing Information
  Comments or Messages Related To Your Donation
* Card Type
* Payment Method
Please select from the available payment methods.
Credit/Debit Card     Check
* Amount of Payment
Format: 45.67 (Include decimal and cents. Do not use a dollar sign.)
* Card Number
* Expiration Date
* Cardholder First Name
The first name of the account holder as it appears on the credit card.
* Cardholder Last Name
The last name of the account holder as it appears on the credit card.
* Bank Routing Number
Nine (9) digit bank routing number
* Bank Account Number
Your account number is typcially six (6) to ten (10) digits.
* Confirm Bank Account Number
* Bank Account Type
* Bank Name
The name of the bank your check belongs to.
* Account Holder's Name
The name of a person who is authorized on this account (Listed in the top, left corner of the check in most cases).
* Card Code Verification Number
The three digit number on the back of your card.
* Billing Postal or Street Address
* Billing City
* Billing State
* Billing Zip Code
5 digit zip code
* Contact Phone Number
Please provide a phone number where we may reach you regarding this payment