To Pay by Check or Credit Card

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


Enclosed, please find my donation to help keep Eaton Community Palliative Care 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

Donations to Eaton Community Palliative Care 
are tax deductible as provided by law.