online donation

PLEDGE

Thank you for your support of the Community Health Clinic of Butler County.
We appreciate this pledge.

*indicates required fields

*Name:

*Address:

*City:

*State:

*Zip Code:

*Phone Number:

*Email Address:

*Donation Amount:

*Please select type of donation:

General Donation
In Memorial of
In Honor of
Partners for a Healthier Community

Partners for a Healthier Community Membership Form:

Diamond ($1,000 or more annually)
Patinum ($750 to $999 annually)
Gold ($365 to $749 annually)
Silver ($250 to $364 annually)
Bronze ($100 to $249 annually

I wish to donate anonymously:

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This gift is in Memory of:

This gift is in honor of:

Person or family's address for acknowledgement:

*Please add my email address to your mailing list:

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Pay by check:

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Checking Account Number:

Routing Number:

Please debit my account:

One time only.
Monthly
Quarterly

Please click on the Donate Button if you wish to donate with a Credit Card.

Website Policies

ACH: I authorize the Community Health Clinic of Butler Co. to inittiate electronic debit entries to my checking account for payment of my donation. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. This authority will remain in effect until I have cancelled it in writing.
Security: This website can secure your private information. It is owned and operated by the Community Health Clinic of Butler County, a 501(3)c corporation.
Privacy: The Community Health Clinic of Butler County does not sell, trade, rent, or share your information with any other entity.
S & H Policy: Shipping and Handling is not an applicable policy as the Community Health Clinic of Butler County does not provide any products.
Return Policy: All transactions are final. The Community Health Clinic of Butler County does not return any funds donated.

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