Donate Online to the Rex Healthcare Foundation | Rex Healthcare Foundation

Online Donation Form NOTE: When filling out payment information on the next form, please enter the credit card's expiration date without the slash (mmyy). If you have problems paying via credit card online please call the Foundation office at (919) 784-4424. Thank you! Thank you for your interest in donating to the Rex Healthcare Foundation. Please fill out the form below and then proceed to fill out payment and billing information after clicking "Submit" at the bottom. Donation Information
* Indicates required information
Please designate my donation as follows: (Check all that apply) *	Unrestricted Cancer Care Nursing Excellence Heart & Vascular Care Women & Children Other If Other, please specify:
Please tell us how you heard about us: (Check all that apply) *	"Inspire" Newsletter Grateful Patient Mailing Obituary Listing Rex Healthcare website Facebook Twitter Other If Other, please specify:
Name: (As it will be displayed in donor listings)
If you would like to make a tribute to someone please provide his/her full name:
Tribute type:	In Memory of In Honor of None
If you would like for us to mail a letter to someone on your behalf please provide their name, address, city, state and zip code:
Check any/all that apply:	I prefer to make my donation anonymously. My company will match my gift. I have included the Rex Healthcare Foundation in my will or estate plan. I would like to consider including Rex Healthcare Foundation in my will or estate plan. I would like to get a copy of the "Inspire" newsletter mailed to my home. I would like someone to contact me about setting up automatic payments to be done monthly, quarterly, or annually.
Payment Information
Amount	If Other, please specify:

Once you click submit you will be directed to a secure payment site. (You will need to disable your browser's Pop-up blocker for the payment window to open.) Rex Healthcare Foundation \| 2500 Blue Ridge Rd, Ste 325 \| Raleigh, NC 27607 (919) 784-4424 \| rex.foundation@rexhealth.com Any information you exchange with this site is protected from view by other Internet users. Any e-mail addresses you enter may be used to send you a verification message, but such addresses will not be used to request personal information of any type nor will any contact details be shared with other companies. Rex Healthcare Foundation uses industry-standard encryption technologies when transferring and receiving payment data. If you have questions, please contact us for more information at (919) 784-4424.