United Hospital - Allina Health

Donation Type

One-time gift

Monthly Gift

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Donation Designation

Field Is Required Gift Designation:

Use my gift where it is needed most.

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If you selected Other, please tell us where you would like to designate your donation

Designation for Autoresponder

Tribute Information

Yes, this is an honor or memorial gift

Honor Gift Type:

Honoree First Name:

Honoree Last Name:

Gift notification options

No notification

Mailed letter

Emailed card

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Recipient Street Address

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Message for the recipient

Yes, Send an eCard Yes, I would like to send an eCard.

Select an eCard:

Donation Ecard Stationery: Memorial Gift

Recipient email address(es):

eCard Subject:

eCard Message:

Yes, send me a copy of the eCard.

Billing Information

Is Business Checkbox

Make this gift on behalf of an organization

Business or Organization Name

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First Name:

Middle Name:

Last Name:

Suffix:

Street 1:

Street 2:

City:

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Country:

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Email Address:

Yes, I would like to receive communication from Allina Health Foundation.

Payment Information

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Credit CardBank Account

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Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

Bank Account Information:

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Bank Account Number:

Verify Bank Account Number:

Account Type:

Checking
Savings

I agree to use my bank account as a payment method and authorize Allina Health to debit my bank account to fulfill my donation commitment.

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