Donation Form Welcome to Hospice of Lenawee's online donation form! All transactions are protected via a secure connection. * = Required Donation Information Title Mr. Ms. Mrs. Miss Dr. Mr. & Mrs. Rev. First Name * Last Name * Spouse Name (If Applicabale) Company Name Street Address * Apt/Unit # City * State/Province/Region * Zip/Postal Code * Country * Phone Email * I wish to receive future email correspondence. I would like information sent to me regarding estate planning. Amount $500 $250 $100 $50 $25 Other Amount: $ Designation Unrestricted Contribution Kathy Goetz Bereavement Endowment Hospice Home (Residence) Lights of Love Hospice Heart Endowment Fund General Endowment Fund This donation is on behalf of a company. I prefer to make my donations anonymously. Payment Information Credit Card Number * Card Type * MasterCard Visa American Express Discover Diner's Club Expiration Month * Choose Month...JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Expiration Year (YYYY) * Cardholder's Name * Card Security Code * Comments This gift is in honor or memory of someone special: In Honor of OR In Memory of To submit your donation, complete the reCAPTCHA and click the Submit button below. Your credit card WILL be charged.