To Pay by Check or Credit Card

Please Print, Complete, and Mail with Check or Credit Card Number to:
Eaton Community Hospice
2675 South Cochran
Charlotte, Michigan 48813


Enclosed, please find my tax-deductible donation to help keep Eaton Community Hospice FREE for those in our community who need it most.

 $____________________

 Name:__________________________________________________


Address:________________________________________________


City:_____________________State:___________Zip:____________

Please use this Donation for:

Memorial Gift in memory of:___________________



Honorarium Gift in honor of:____________________

If Paying by Credit Card, Please Bill My:


(   ) Visa          (   ) Master Card          (   ) Discover


Credit Card Number:_______________________________

Expiration: ________________

Signature:________________________________________

Please inform of my donation in memory/in honor
 of their loved one

 Name:__________________________________________________


Address:________________________________________________


City:_____________________State:___________Zip:____________

Thank You!
Your Donation is Greatly Appreciated