Hospice of the Upstate

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Thank you for supporting Hospice of the Upstate’s Butterfly Release. Your gift will help us continue a long tradition of the highest quality of end of life care.
Please enter your donation in the box below.

Qty

Description

Amount

Total

Butterfly

$25.00

---

Butterfly with Butterfly Garden Stake

$50.00

---

Dove

$100.00

---

Dove with Butterfly Garden Stake

$125.00

---

I will cover the credit card and online processing fees associated with my donation. If yes, 2.5% will be added to the donation. Uncheck the box if you do not wish to pay the fee.

Total: $0.00

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone:

E-mail: *

A receipt will be e-mailed to this address.

I will attend the Butterfly Release on May 21st:

Check here to receive our newsletter.

I would like information about becoming a volunteer.

Memorial/Honorarium Information:

Tribute Gift Type:

Memorial/Honorarium Name:

Send acknowledgement information to:

Name:

Address:

City, State, Zip:

Your Payment Information:

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *