Malvern Retreat House Secure Online Memorial Gifts Donation Form



Secure Online In Lieu of Flowers Donation Form

Please note that fields with an asterisk (*) are required.
For your security, this form will not work if you use the AutoFill feature in your browser.

*Gift Amount:   $  .00
*Gift Frequency: 

*First Name:  *Last Name: 
*Address 1:  Address 2: 
*City:  *State: 
*Zip Code:  *E-mail: 
*Daytime Phone #:  Evening Phone #: 


*Payment Type:   Credit Card   Check 

If by Credit Card: 

If by Check: 
*Credit Card Type: 
*Credit Card #:  *Routing #:  Where do I find this?
*Exp. Date:  / *Checking Account #:  Where do I find this?

If this gift is being made  in honor   in memory   N/A 
Please provide full name of person being honored/remembered: (No commas or characters, please.)

I am interested in leaving Malvern Retreat House in my will. Please contact me.  Yes   No 
I have remembered Malvern Retreat House in my estate plans.  Yes   No 
Is your employer a matching gift corporation?  Yes   No 
Employer information: (No commas or characters, please.)

Prayer Request/Comments: (No commas or characters, please.)

After ensuring that all of the information above is correct,
please click the Submit Form Now button ONLY ONCE.
Multiple clicks of the Submit button will result in duplicate charges to your account.
An e-mail confirmation will be sent to the e-mail address you provided.


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Malvern Retreat House
P.O. Box 315 • Malvern, PA 19355-0315 • Phone: (610) 644-0400 • Fax: (610) 644-4363
Send us an e-mailwww.MalvernRetreat.com


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