Charitable Contribution Form

Charitable Outreach Section

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Charitable Contribution Form

There are many advantages to electronic bank transfers. You never have to worry about a check being lost in the mail and most importantly, it's safe and free. You may have any amount (minimum $10) automatically deducted from your checking account or debited to a credit card monthly. Just like electronic banking, your generous contribution is automatically transferred. Just complete the electronic form and then mail a first payment check (so we can list the correct routing information) to:

St. Barnabas Charities
5850 Meridian Road
Gibsonia, PA 15044
724-443-0700

Or, if you would like to have your contribution charged to your credit card each month, please make that indication on the form.

Name
Address
City
State
Zip
Phone
E-mail
Total Gift Amount
Monthly Deduction Amount
I prefer to have my gift deducted from my checking account
I prefer to have my gift debited to my credit card (please fill out credit card information below)
Master Card
VISA
American Express
Discover
Account Number
Expiration Date
Name as it appears on card

I would like to designate my gift toward the following fund:

Free Care Fund
Brown Bag Fund
Fuel Fund
White Goods Fund
St. Barnabas/Valencia Woods Auxiliary
Presents for Patients
Pennies for Patients

Please send me more information about:
(select as many as apply)

Including St. Barnabas Health System in My Will or Trust
Charity Programs and Events
Presents For Patients
Pennies for Patients
Planned Giving
Prayer Requests
Endowed Gifts

I was referred to the St. Barnabas Health System Website by:

Friend/Family Member
Current St. Barnabas Resident
Yellow Pages
TV Advertisement
Radio Advertisement
Newspaper Advertisement
Billboard
Direct Mail
Clergy Person
Other