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Thank you for your gift.

Please complete each of the following fields.  Fields with an* are required to process your gift.  If you wish to have a hard copy acknowledgement mailed to you, please provide your mailing address.

If you wish to make a memorial donation, click Memorial Donation in the drop down list under the Donation Type box.

Note: gifts made via this on-line portal cost us 2.2% plus $.30 per transaction.   Consider printing this form and mailing it and your check to:


PO Box 550

Canaan, NH  03741

Revised 10/29/19

Mascoma Community Healthcare, Inc., is highly sensitive to the privacy interests of our donors and believes that the protection of those interests is one of its most significant responsibilities. In acknowledgment of its obligations, we have adopted the following Privacy Policy applicable to information about donors that it acquires in the course of its business:

1. Acquisition of Information. We do not acquire any more information about donors than is required by law or is otherwise necessary to provide a high level of service efficiently and securely.

2. Our Employees and Privacy. We train all of our employees about the importance of privacy. We give access to information about donors only to those employees who require it to perform their jobs.

3. Security Measures. We make access to privacy-sensitive information subject to rigorous procedural and technological controls, consistent with legal requirements and the demands of customer service.

4. Disclosure to Third Parties. We will provide individually-identifiable information about donors to third parties only if we are compelled to do so by order of a duly-empowered governmental authority, we have the express permission of the donor, or it is necessary to process transactions.

5. Privacy and Our Business Partners. We will not disclose donor information to our business partners.

Donations are non-refundable