Donation Form - Hosparus
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1Donation Form
Please mail this form with your donation to:
Hosparus
3532 Ephraim McDowell Drive
Louisville, KY 40205-3224
Important Information
*All donations are 100% tax deductible
*For each check, please use separate donation form
*Check to see if your employer matches gifts
*If you donate $10 or more, you will receive a tax receipt
For information about Hosparus visit .
Your privacy is important to us. We do not sell, rent, share or otherwise disclose personal information about our donors.
Donor Information
Matching gift
First
Last
Company
Address
City
State
Zip
Phone
Email
I would like to be contacted about leaving Hosparus in my will.
Donation Amount
$1,000
$500
$100
$50
$25
Other $_________
Choose Your Hosparus Community
Barren River
Central Kentucky
Green River
Louisville
Southern Indiana
Area of Greatest Need
Payment
Check enclosed (make payable to Hosparus)
Visa
MasterCard
American Express
Discover
Credit Card Number:________________________________________________ Expiration: ___________
Signature:________________________________________________________ Date: _______________
Donations are nonrefundable and nontransferable. Thank you for supporting Hosparus!
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Parent category: Business