Company Donation

Currently we have an urgent need for our upcoming Palau Gynocology Mission. The reagents that the pathology processor uses are alcohol based and the shipping company is requiring a special service to pack this “hazardous” material.  The crating and shipping cost is $3,900 – that’s $3,900 more than the budget.

COMPANY ACCOUNT INFORMATION

This form is designed for company accounts. If your company is making a donation, then you are using the correct form. However, if you are an individual making a donation, please switch to the Individual account form. Button on the top right.

YOUR COMPANY INFORMATION

Please tell us about your relationship within your company.

CONTACT INFORMATION

We need a little information about the company itself.

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Note to Staff

Special processing instructions or a note to staff?

ACCOUNT LOGIN INFORMATION

If you would like to manage your account (i.e., view donation history, change address, etc.), please create a login name and password. This option will give you access to speciality forms and as such it is recommended to establish an account.

NeonCRM by Neon One