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 should get a confirmation email. If you do not get the email, your donation did not go through - 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

MaineHealth Unrestricted is the default option. Other location and designation options are listed in alphabetical order. Please make sure to select your preference if you don't want the MH default.

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). The more detail you provide, the quicker and easier delivery will be. 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