Yes,
I want to support Valleywise Health Foundation!
Name
Address
City, State, Zip
Email Mobile
Employee ID#
Give Today. Impact Tomorrow. Additional Options
One Time Donation
$
Friend
Donate $130/year = $5.00/pay period
Payment Details
Advocate
$250/year = $9.62/pay period
Check (Payable to Valleywise Health Foundation)
Leader
Visa
$500/year = $19.23/pay period
Mastercard
Discover
AmEx
Ambassador
$1,000/year = $38.46/pay period
CARD NUMBER
Angel
$2,500/year = $96.15/pay period
CCV
EXPIRATION DATE
Founder
$5,000/year = $192.00/pay period
NAME ON CARD
S I G N AT U R E
D AT E
Payroll deduction will continue until you notify the Foundation to change the amount or cancel.
Thank You.
To modify your deduction at any time, contact the Valleywise Health Foundation office, 602-687-9031