Online Donation

Make a Donation Online Today

You may make a gift by credit card by filling out the online form below.

  • If you would like your gift to be designated for a particular hospital department or use, please so indicate in the “Additional Comments” section.
  • If you have any difficulty making this transaction, please contact Mary Sernatinger (msernatinger@pmhc.us).

You can also make a gift to Phelps by check. Please print and complete this form and mail it with your check to:

Phelps Hospital
Development Office
One Phelps Lane, Suite 106
Sleepy Hollow, NY 10591

Thank you.


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Your Information

First Name * Last Name *
Email *    
    Check here if you would not like to receive emails from the hospital.

Billing Information – Please use the same address as your credit card.

Address Line 1 * Address Line 2
City * State *
Zip Code * Phone *

Payment Information

Name on Card * Type of Card *
Card Number * Expiration *
CSC *
CSC Security Code
Contribution/
Payment *
$
Gift Usage
Comments
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Gift In:  
Honor of
Memory of
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Please notify the following person that a special gift has been made:
Name
Address
  I would prefer to make this donation anonymously.
  My company will match my gift. (Please send completed matching gift form to the address at the top of this form.)
  I would like to learn more about including Phelps in my estate plans.
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Security Question * What number is in the blue box?