Online Giving - PayPal
Donate safely and securely, using your credit card.

To submit a gift online, please complete the required fields(*) below and click the "Submit" button. You will then be directed to a Pine Rest Giving Page within Paypal, our authorized online payment processing service. Because we are committed to the utmost security and protection of the credit card and bank account information of our supporters, you will not be asked to provide any financial information until you enter the secure site of Paypal.

Gift Information
I wish to support the ministries of Pine Rest.
*Choose one of the options below:
Please Us My Gift: [Select one:]   Where Most Needed   Patient Assistance Fund   Addiction Services   General Endowment   Iowa Endowment   Pine Rest Foundation   Endowment for Persons with Developmental Disabilities I wish to designate my gift to a specific Pine Rest ministry:   Inpatient Services   Developmental Disabilities Services   Family Institute   Psychological Consultation Center   Belknap Commons Clinic   Caledonia Clinic   Campus Clinic   City Clinic   ECT Clinic   Northeast Clinic   Northwest Clinic   Rockford Clinic   Southwest Clinic   Wyoming Clinic   Greenville Office   Kalamazoo Clinic   Grand Haven Clinic   Holland Clinic   Mercy-Muskegon Clinic   St. Joseph Office   Zeeland Clinic   Des Moines (Iowa) Clinic   Pella (Iowa) Clinic
Personal Information
Please accept my gift to help the ministry of Pine Rest provide healing and hope for the thousands of individuals, children, older adults, and families in our communities struggling with mental health issues, substance abuse, and/or developmental disabilities.
	Prefix:		[Select...] None Mr. Mrs. Ms. Miss Dr. Rev.
	*First Name:
	*Last Name:
	Middle Initial:
	*Address:
	*City:
	*State:		[Select...] AL AK AR AZ CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
	*Zip Code:
	Home Telephone:
	Office Telephone:
	*Email:
Name(s) as you would like it to appear in the Pine Rest Foundation Annual Report if different than above.
	Printed Name:
Gift Options
Please check all that apply:
	This gift is in honor a memorial gift in honor of
	Send an acknowledgment letter to:
	Name:
	Address:
	City:
	State:		[Select...] AL AK AR AZ CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
	Zip:
	My employer has a matching gift program.
	Employer Name:
	Address:
	City:
	State:		[Select...] AL AK AR AZ CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
	Zip:
	Employer Phone:
Additional Information
	I/We would like more information about planned gifts. Please have Randall Johnson contact me/us.
	I/We have included Pine Rest in my/our trust/will.
	I/We would like information about how our church/group can support Pine Rest.
I/We would like to receive copies of (check all that apply):
	Pine Rest Christian Mental Health Services Annual Report
	Foundations for the Future (Planned Giving Newsletter)
Comments
	Please enter any comments here: