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Glendive Medical Center

Foundation Donations

Please fill out the following to make a gift to the Glendive Medical Center Foundation. Sorry, no donations made on this site are refundable. Thank you for your contribution.

Print Donation Form
Please print a copy of this and mail it with your check made payable to:
Glendive Medical Center Foundation
202 Prospect Drive
Glendive, MT 59330.
* Name
* Address
* City
* State
* Zip Code
* Telephone
(area code first)
* Email
* Gift for
Please direct my gift for
Unrestricted-Use in the area of greatest need
Annual fund for GMC
Hospice
Endowment
Hospice Endowment
Other
  If Other, please specify where you would like to direct your gift
  My gift is
 
please tell us who you are donating in memory or honor of in the box to the right.
Credit Card Details
* 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.
* Amount of Payment
Format: 45.67 (Include decimal and cents. Do not use a dollar sign.)
$
* Card Number
* Expiration Date
* Card Code Verification Number
The three digit number on the back of your card. (Four digit code on the front of American Express.)
* Email Address
* Billing Postal or Street Address
* Billing City
* Billing State
* Billing Zip Code
5 digit zip code