Mercy Hospital - Allina Health

Donation Type

One-time gift

Monthly Gift

Donation Amount

Donation Designation

Field Is Required Gift Designation:

Use my gift where it is needed most.

Direct my gift to:

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

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

Notification Recipient Name:

Recipient Street Address

Recipient City

Recipient State

Recipient Zip Code

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

Title:

First Name:

Middle Name:

Last Name:

Suffix:

Street 1:

Street 2:

City:

State/Province:

ZIP/Postal Code:

Country:

Phone Number:

Email Address:

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

Payment Information

Payment Method:

Credit CardBank Account

Credit Card Information:

Credit Card Type:

Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

Bank Account Information:

Bank Routing Number: What is this?

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.

Support the Mercy Hospital Fund

Every Gift Impacts Our Care