OUR Place Employee Giving - Credit Card

Please complete the form below to make a gift by credit or debit card. A minimum gift of $10 is required to receive an OUR Place Employee Giving t-shirt.

Once you click submit, you will receive a confirmation email. If you do not, please try submitting the form again.

Please contact our Philanthropy Department at development@mainehealth.org or 207-662-2669 with any questions.

Donation Information

Amount:

Gift

$ 1,000.00

Gift

$ 500.00

Gift

$ 250.00

Gift

$ 100.00

Gift

$ 50.00

Gift (minimum required to receive a t-shirt)

$ 10.00

Other

Designation options are listed in alphabetical order. Please select your preference.

Additional Information

Your t-shirt will be delivered to your work location as soon as possible. In order to do so, please make sure to provide detailed work delivery location information (ex: Philanthropy, 7 Bramhall St, Portland, 2nd floor, room 306). Unfortunately, we cannot mail to home addresses.

Full Work Location (dept, address, bldg, fl, etc.):

T-Shirt Size:

Billing Information

Title:

First name:

Middle name:

Last name:

Country:

Address lines:

City:

State:

ZIP:

Phone:

Email:

Confirm Email:

Payment Information

Once you click submit, you will be prompted to enter your credit card information.

Payment Method:

Credit Card

Direct Debit