Gift Card

GIFT CARD

Use this gift card to send in a donation today to help support Morrill County Community Hospital and Morrill County Hospital Foundation.

Name: ____________________________________

Address: ____________________________________

City: _____________________ State: ____ Zip: __________

In support of Morrill County Hospital's Foundation,

Please accept my gift of _____________ or pledge of ________________

to be paid over _____ years starting (month) __________ (year) _________

Signed: __________________________________ Date: ______________________

Please bill: ___ Annualy ___ Semi-annualy ___Quarterly

Other: ________________________________________________________

I'm interested in payroll deduction from my company.

Company Name: _______________________________________________

Address: _________________________________________

City: _______________________________ State: _____ Zip: ___________

For Office Use Only

Pledge: _______________

Paid now: _______________

Balance: _______________

All gifts are fully deductible.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

To ensure confidentiality, please send this pledge in an envelope to:

Morrill County Hospital Foundation

PO Box 75

Bridgeport, NE 69336

Thank you from Morrill County Hospital Foundation.