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GIFT PLANNING WITH UNITED CHURCH HOMES

Please take a moment to read through the whole form and then have your credit card ready and fill out the questions that apply to your gift. As always, we thank you in advance for your contributions.

If you wish to make an alternative donation of an item to a particular community, please contact us for a current "Needs List" from that community.

Step 1: Choose Your Giving Level
Donation $50 - 75
100+ Club Circle $100 - 249
Matthew & Jane Smith $250 - 499
Rainbow $500 - 749
Robert & Eleanor Diller $750 - 999
President's $1,000 - 2,499
Elizabeth B. Herbster $2,500 - 4,999
Ruth F. Parker $5,000+

Decide which Giving Level you would like to belong to, and enter the an appropriate annual giving amount in the Amount box that correlates with that Giving Level.

Amount: $
Step 2: Memoriums and Honorariums

Use this option of you'd like your donation to be made in the memory or honor of a loved one. If not, please skip and go to the next field.
Donation in the Memory of
Donation in Honor of
Step 3: Choose a Community

Many of our donors wish to designate their money to a specific United Church Home Community. If this is your desire, choose the community from the drop-down menu below. If not, skip this and move on to step 4.
Select a Community from the drop-down menu:
Step 4: Contact Information
E-mail Address:
May we contact you by e-mail? Yes No


The following information must be typed exactly as it appears on your credit card:
Name:
Suffix:
Company/Organization Name:
Address Line 1: (e.g. 1234 Main St.)
Address Line 2: (e.g. Suite 102)
City:
State/Province:
Postal Code: (e.g. xxxxx-xxxx)
Country:
Daytime Phone: (e.g. (###) ###-####)
Evening Phone: (e.g. (###) ###-####)
Step 5: Submit Payment Through Verisign

We accept Visa and MasterCard
Handicapped Accessible United Church Homes Equal Housing Opportunity

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United Church Homes • 170 E. Center Street • Marion, Ohio 43302
Phone: (800) 837-2211 or (740) 382-4885 • Fax: (740) 382-4884 • TTY: 1-800-750-0750