Mission of Mercy : Donate : Give On-Line

Mission Statement
Mission of Mercy, a non-profit organization, seeks to restore dignity to all people by being an instrument of “healing through Love,” and by the reciprocal sharing of God’s mercy with those we serve.

Please complete and submit the following form:
* Denotes Required Field

I want to Adopt-A-Patient and become part of your mission to restore dignity and bring “healing through Love.” *

$1,000 dispenses 500 free prescriptions
$500 provides 12 patient visits+
$250 cares for one family for a year+
$120 cares for one patient for a year+
$40 provides one patient visit+
Other $

+Visit includes treatment by physician or dentist, all prescription medications, all lab and x-ray tests and referrals to specialists or surgery.

Please use my donation to support the following: (undesignated gifts will support these and other activities of Mission of Mercy)

Mission of Mercy's Greatest Need
Maryland / Pennsylvania Medical Program
Arizona Medical Program
MOM’s Family Auxiliary

I wish for my donation to be billed:*

One-Time Donation
Monthly Donation
Quarterly Donation

My contribution is in honor/memory of:

Honor
Memory

Please notify the following of my honor/memory gift:

Please indicate: Mr. Mrs. Ms. Mr. & Mrs. Other
If other please specify:

Name:

Address:

City:

State:

Zip:

Email Address:

Phone Number:

Donor Information:

Please indicate:		Mr. Mrs. Ms. Mr. & Mrs. Other If other please specify:
Name:		*

Address:		*
City:		*
State:		*
Zip:		*

Email Address:		*
Phone Number:		*

Credit Card Type:		*
Number:		*
Expiration Date:		/ *
Name on Card:		*

Please send information about Mission of Mercy to my friend:

Name:

Address:
City:
State:
Zip:

Email Address:

All donations are tax deductible
Tax ID # 86-0704883

Required State Disclosure

A current financial statement is available from Mission of Mercy by contacting the Executive Director, P.O. Box 102, Fairfield, Pennsylvania, 17320, or by calling (301) 447-3939. For the cost of postage and copies, these documents and other information are also available from the office of the Maryland Secretary of State.

The official registration and financial information of Mission of Mercy may be obtained from the Pennsylvania Department of State by calling toll free, within Pennsylvania, 1 (800) 732-0999. Registration does not imply endorsement.

Additional information regarding the Arizona Clinic is available by calling the Executive Director, (480) 424-7171, or the Arizona Secretary of State, charitable Division, 1 (800) 458-5842.