Donations by Credit Card
      We cannot take online donations by credit card at this time; however, you may print, fill out and mail the form below to Gaston Hospice, P. O. Box 3984, Gastonia, NC  28054.

Donations by Check
      To donate by check, you may print, fill out and mail the form below to Gaston Hospice, P. O. Box 3984, Gastonia, NC  28054.  Please make checks payable to Gaston Hospice.

Name: ____________________________________________________

Address: __________________________________________________

City: _____________________ State: _______ Zip: _______________

Phone Number: ____________________________________________

My gift amount: _____________________

Whom gift is given in honor or memory of: _______________________

Use my gift for

____ Robin Johnson House
____ General Hospice Care
____ New Hope Counseling Center

I am paying by:
____ check
____ credit card

If paying by credit card,
Name on Card: ____________________________________________

Type of Card:
____ Visa                            ____ American Express
____ Master Card                 ____ Discover Card

Card Number: _____________________________________________

Expiration Date: ___________________________

Card Billing Address: ________________________________________

City: _____________________ State: _________ Zip: _____________

Phone Number: ___________________________

Web site designed by
Kevin E. Murray