DONATION FORM - Credit Card or ACH
The form below allows you to make contributions to the Transplant Fund or CARES Fund
Fund Choice and Percent of Donation
Transplant Fund Percent
Please select...
25
50
75
100
The Transplant Fund is the general fund for the FMC Foundation, focusing on raising awareness of kidney disease and transplantation as a lifesaving solution.
CARES Fund Percent
Please select...
25
50
75
100
The CARES Fund provides financial assistance to employees affected by unforeseen emergency situations, such as disasters or hardships.
Total Donation Percent
Contact Information
Relationship to Fresenius Medical Care
Please select...
Employee
Patient
Caregiver/Family
Physician/Care Provider
Vendor
Third Party Fundraiser
First Name
Last Name
Phone
Email
Employee ID #
Preferred Name for Recognition
This is how your name will appear on any public recognition. Consider whether you’d like to include your middle name or initial, spouse’s name or charitable fund. For guidance, doctors are listed as Dr. John Doe (instead of John Doe, MD) and couples are listed in alphabetical order by first name.
Donation Information
Dollar Amount
Do not enter commas or dollar signs
Select Donation Frequency
Please select...
One Time Donation
Weekly
Monthly
Quarterly
Annually
Start Date
Enter an End Date?
No
Yes
This is to select the frequency of your donation. You can email the
Foundation
at any time to stop your donations.
End Date
Is this donation in Honor or in Memory of anyone?
Please select...
No
Yes, In Honor
Yes, In Memory
In Whose Name
This will be the name In Honor or In Memory of.
Notification Preference
Please select...
Do Not Notify
Email
Notification Recipient's Email
Email address of the person who shall receive the notification of your gift.
Who Shall We Notify?
Name of person to notify you made this gift.
Payment Information
Payment Method
Please select...
Credit Card
ACH Bank Debit
Credit Card
Name on Card
Card Number
MM
YY
CVV/CVC
ACH Bank Debit
Name on Account
Bank Name
Bank Routing Number
Bank Account Number
Prefix
Billing Account Number
Account Type
Checking
Savings
Are you paying an invoice?
Yes
No
Invoice #
Billing Email
Billing Address
Address Line 1
Address Line 2
City
State/Province
Postal Code
Is your Mailing Address different than your Billing Address?
Yes
No
Mailing Address
Address Line 1
Address Line 2
City
State/Province
Postal Code
Campaign ID
Contact Information