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Thank you for choosing to make a gift to Hospice of Northwest Ohio. After you submit this form on our secure site, you will receive an email confirmation that your gift has been received. In addition, you will receive an acknowledgement of your gift via U.S. mail. You can also download a form here to print out and send via U.S. mail.

If your gift is being made in memory or in honor of someone, we will notify the individual you are honoring or the family members of the person you are remembering of your gift. Please be sure to provide complete contact information for these individuals on this form.

If you would like to discuss a major gift or are interested in supporting a certain project, please contact:

John Lechman, CFRE
Vice President, Philanthropy
Phone: 419-931-5187

* = Required

I would like to make a donation to Hospice of Northwest Ohio.

I would like to donate:

 I would like to make a recurring donation.

Donor Information

Name of Donor
Phone Number (xxx-xxx-xxxx)
 This gift is from another individual or organization.
 This gift is from a group of people.

Is this Gift in Memory or Honor of Someone?


Please select one category for your gift.

 Gift is a memorial or general donation and should be used where the need is greatest
 Gift is in support of a special event or project

Matching Gift Program?
Many area employers sponsor matching gift programs for employees or retirees. This could double your gift to Hospice of Northwest Ohio.

 My employer has a matching gift program.

Donor Address

(must match billing addess for credit card)
Address 2

Credit Card Information

Selected Donation
Select Card Type
(as it appears on the credit card)
Card Number
(no dashes or spaces)
Exp. Date
Comments for HNO in processing this donation.

Before submitting this form, please click on the link below to move the contents of box "A" into box "B" leaving the first box empty.

A: B: Click to Move