It's Your Community Hospice

Make a Financial Contribution

If you would like to make a difference in the lives of children and adults with life-limiting illnesses in Northeast Florida by making a charitable donation, please complete and submit the following secure online form. All donations will be processed within 48 hours. If you wish to receive a refund for any reason after making your contribution, please contact Community Hospice Foundation at 904.886.3883.

You also may print, complete and mail your donation form directly to:

Community Hospice Foundation
4266 Sunbeam Road
Jacksonville, Florida 32257
Call 904.886.3883 or e-mail us for more information.

Please remember to print an extra copy for your records prior to submitting your online donation.

Personal

Title

First Name

Last Name

Organization / Company Name

Address

City

State

Zip

Home Telephone

Cell Phone

Organization / Company Phone

E-mail Address

Amount of Donation

$ Amount

$25 $50 $75 $100
Other

I would like my contribution to go specifically towards:

Payment Options

Credit Card

VISA MasterCard Discover

Credit Card Number

Expiration Date (MMYY)

Security Code (3 digits)

In Memory of
(Deceased)

In Honor of
(Living)

Acknowledgment Card

We will send donation notification to the person identified below. This person will be notified that a gift has been made in honor/memory of his/her loved one, but we will not disclose the donation amount.

Send

Yes No

Name

Address

City

State

Zip

My/my spouse's employer participates in a Matching Gift Program.
I will obtain the appropriate form from the company's personnel office and mail it to the Community Hospice Foundation.

Yes, I would like to receive additional donation envelopes.

Yes, I would like to receive information on gifts that pay me income for life and gifts through wills, insurance and other estate gifts.

Please type the characters shown for image verification.

Comments

If you are listing more than one donor, honoree or memorial name, please use the Comments field to list the additional information.

Community Hospice of Northeast Florida is a 501(c)(3), not-for-profit organization. Professional solicitors are not used; 100 percent of your contribution goes to Community Hospice.

A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION FOR COMMUNITY HOSPICE FOUNDATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE WITHIN FLORIDA (1.800.435.7352). REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL OR RECOMMENDATION BY THE STATE. CH482.

Print this form.

The donation process may take a few minutes. Click "Make Donation!" button only once or you may be charged for multiple donations.