Donate | Forsyth Community Clinic

Donor Information

First Name

Last Name

Home Address

City

State

Zip Code

Email Address

Phone Number

Credit Card Donation

All credit card donations will incur a 3% processing charge to offset the credit card processing fees. Thank You!

Frequency of Your Donation

One-Time Donation

Recurring Donation (monthly)

Recurring Donation (every 3 months)

Recurring gifts will occur perpetually until you notify our office to stop payments. You may provide special instructions in the "Donor Notes" field below.

One-Time Amount

$10

$25

$50

$100

$250

$500

Other…

Monthly Recurring Amount

$5/month ($5.15/month charged)

$10/month ($10.30/month charged)

$25/month ($25.75/month charged)

$50/month ($51.50/month charged)

$100/month ($103/month charged)

$250/month ($257.50/month charged)

Quarterly Recurring Amount

$50/quarter ($51.50/quarter charged)

$125/quarter ($128.75/quarter charged)

$250/quarter ($257.50/quarter charged)

$500/quarter ($515/quarter charged)

$1000/quarter ($1030/quarter charged)

$1,250/quarter ($1287.50/quarter charged)

Donor Notes

Payment Information