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Donate by Check

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One-time Donation or Pledge by Check

 

Thank you for partnering with us.  Please fill out the form below and mail your check to:

Safe Harbor Pregnancy Medical Center
2280 N. 9th Avenue
Pensacola, FL  32503
1. *

First Name(s):
2. *

Last Name:
3. *

E-Mail Address:
4. *

Street Address:
5. *

City:
6. *

State:
7. *

Zip Code:
8. 

Preferred Phone: (###-###-####)

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ONE-TIME DONATION

If you are making a one-time donation, please indicate the amount below.
9. 

Donation Amount:

 
$50.00 $100.00
$250.00 $500.00
$1,000.00 Other (Please specify below.)
10. 

Other Amount (Example - 125.00):
11. 

When should we expect this gift?

 
Immediately (It's on the way!) Future Date (Please indicate below.)
12. 

Future Date:

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RECURRING DONATION (Ongoing Pledge)

If you would like to make an ongoing pledge, please fill out the information below.  Please indicate the frequency of your gift and the amount of each gift.
13. 

Recurring Pledge Frequency:

 
Monthly Quarterly
Every 6 Months
14. 

Amount of Each Gift (Example - 50.00):

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Please check the box next to "I'm not a robot," then click on "SUBMIT" below.   Our office staff will receive an e-mail with your donation information.