Please Print this GIFT FORM, complete and mail with your donation to:

Mercy St. Vincent Foundation
2213 Cherry Street, Suite 307
Toledo, OH 43608

Enclosed is my/our gift of $
(make checks payable to Mercy St. Vincent Foundation)

You may use your Visa or Mastercard (check one)
Card Number
Expiration Date
Your Signature

Your Name
Address
City State Zip

My Gift is for:
Where needed most
The Nursing Fund for Excellence
The Physician Fund for Excellence
Mercy Children's Hospital Foundation
The Regional Burn Care Center Fund
Northwest Ohio Heart Center Fund
Marguerite d'Youville Program
Life Flight - Trauma Fund
Home Away From Home Fund
Palliative Care Fund
Family Care Center Fund
Pastoral Care Fund
Senior Outreach Program
Oncology Services
Women of Toledo Fund
Obstetric Services
Neonatal Intensive Care Unit
Other
(See list of other funds available)

This Gift is:
in memory of
in honor of

Please notify the following individual/family that a tribute gift has been received. (The amount of the gift will not be disclosed.)
Name
Address
City State Zip

Leave a Legacy:
I have remembered the Foundation in my estate

Please send me:
Information about endowing a fund in my name or the name of someone special
Information about wills and estate planning

Mercy St. Vincent Foundation is an exempt organization as defined by Section 501(c)(3)of the US Internal Revenue Code and, accordingly, your gift is deductible to the full extent permitted by law.