Centerstone Employee Giving – Credit Card Switch to Credit Card Switch to Evergreen Switch to Payroll Deduction "*" indicates required fields Step 1 of 3 33% NAME (as listed with HR):* First Name Last Name Email* CENTERSTONE STAFF ID (available in Workday):*HOW I WOULD LIKE TO BE RECOGNIZED (if different than NAME above, i.e. Robert vs Bob):ADDITIONAL OPTIONS: I prefer my donation be recognized as "Anonymous" I AM BASED/LOCATED IN THIS STATE:FloridaIllinoisIndianaTennesseeOtherMy base/location state: I WOULD LIKE TO GIVE (click and choose one):** $25 $50 $100 $250 $500 Other Other - Amount Total WHERE I WOULD LIKE MY DONATION TO BE USED (click and choose one):*Brighter Future FundCapital CampaignCARES Fund (direct client assistance)Changing Lives Together Fund (Area of Greatest Need)Endowment (securing Centerstone's future through philanthropy)Military ServicesResearch Institute/National Mental Health Research FundCARES Fund (direct client assistance)Anywhere at CenterstoneFloridaIllinoisIndianaTennesseeChanging Lives Together Fund (Area of Greatest Need)Anywhere at CenterstoneFloridaIllinoisIndianaMilitary ServicesTennesseeMilitary ServicesNational Veterans Counseling FundCohen Military Family Clinic - Clarksville, TNCohen Military Family Clinic - Fayetteville, NCCohen Military Family Clinic - Jacksonville, FLCapital CampaignCapital Campaign - UnrestrictedCapital Campaign - Military Services - National Veterans Counseling FundCapital Campaign - Military Services - Cohen Clinics - UnrestrictedCapital Campaign - Military Services - Cohen Clinic - ClarksvilleCapital Campaign - Military Services - Cohen Clinic - FayettevilleCapital Campaign - Military Services - Cohen Clinic - JacksonvilleCapital Campaign - Institute - Simulation Training CenterEndowmentThe A John Rose Endowment FundThe Barry S. Hale Endowment FundThe Bonnie Brackett Endowment FundThe Brad Smith Endowment FundThe Carol Zwick Endowment FundThe Chris Julian Fralish Endowment FundThe Colleen Thayer Endowment FundThe Dana Oman Endowment FundThe David J. Emmert Endowment FundThe David Melby, PhD, Endowment FundThe Deborah Taylor Tate Endowment FundThe Dede Wallace Fund (supports services in TN - Davidson and contiguous counties) - *RThe Doug Leonard Endowment FundThe Dr. Raghu Upender Endowment FundThe Dr. Stephen J. Pritchard Endowment FundThe Duke Legacy Endowment Fund (supports care in Florida)The Ella P. Hayes Fund (supports services in TN) - *RThe Geoff McKim Endowment FundThe George Bullard Stadler Endowment FundThe George Spain Research Fund (supports behavioral health research) - *RThe Jack Wallace Endowment FundThe James E. Sweeten Endowment FundThe Janet Ayers Endowment FundThe Jennifer Embree Endowment FundThe Jennifer L. Bencie, MD Endowment FundThe Joan C. Sivley Endowment FundThe Jonathan Morphett Endowment FundThe Joseph E. Roche Endowment FundThe Josie Seybold Endowment FundThe Kelly Crockett Endowment FundThe Lee Ann Summers Ingram Endowment FundThe Lee Brackett Endowment FundThe Lieutenant General (Retired) Hubert G. Smith Endowment FundThe Linda Trader Endowment FundThe Lisa Hooker Campbell Endowment FundThe Mark Faulkner Endowment FundThe Michael J. McCalip Endowment FundThe Mike Enos Endowment FundThe Philip D. Krebs Endowment FundThe Philippa M. Guthrie Endowment FundThe R. Parker Griffith Endowment FundThe Reed Farley Endowment FundThe Reverend Bob Phillips Endowment FundThe Reverend James T. Golden Endowment FundThe Richard D. Sivley Fund (A) (supports children and youth services in TN - Davidson and contiguous counties) - *RThe Richard D. Sivley Fund (B) (supports children and youth services in TN) - *RThe Richard H. Fitzgerald Endowment FundThe Sally Sheahan Endowment FundThe Steven C. Holman Endowment FundThe Steven E. Bryant Endowment FundThe Terrye Davidson Endowment FundThe Thomas W. (Tom) Mahler, Jr. Endowment FundThe Timothy A. Knowles Endowment FundThe Tom Johnson Endowment FundOther Restriction (state/program) Billing Address* Street City State StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Zip Code Mailing Address Same as Billing Address Street City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Tax Receipt Options Electronic only - emails as entered above. Electronic with paper copy mailed Payment Method* Help by Covering Transaction Fees? Yes, I'll help. Payment Processing Fees Price: $0.00 Payment Processing Fees Price: $0.00 Total Payment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Card Type American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Card Expiration Date Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 CVV Code Cardholder Name EmailThis field is for validation purposes and should be left unchanged.
