Employee Day of Giving- Give Using A Credit Card - NEA Baptist Charitable Foundation

Your Information:

First name*

Last name*

Email*

Cell Phone

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Department (For NEA Baptist Colleagues)

Choose the programs you would like to Sponsor

Below are the 10 NEA Baptist Day of Giving Funds. You may support as many funds as you like. Please mark the funds you want to support and the dollar or PTO amount per fund.

Auxiliary Mammogram Fund Amount*

Community AED Fund Amount*

Friends of Nursing Fund Amount*

Chaplain’s Fund Amount*

Marc Ford Patient Assistance Fund Amount*

Grief Center Fund Amount*

Center for Healthy Children Fund Amount*

ShareHope Family Amount*

Employee Assistance and Samaritan Fund Amount*

Emergency Medicine Fund Amount*

Total

$0.00

Payment method:

Amount to Donate

$0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

I authorize my employer to deduct this amount from my paycheck. I understand this authorization is a one-time or multi-check gift depending on my above preference. I understand all personal information will be kept confidential.*

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