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Contribution Authorization

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  • Applications must be received no later than September 13, 2018. Authorization notification will be sent on or after October 1, 2018 and no later than October 15, 2018. Payments are not accepted without an authorization number. After submitting this form, you will be provided with a number by the Health Research Inc. office and a link to complete your payment.
  • Please enter your first and last name
  • Health Research, Inc. is a nonprofit corporation organized under the New York State Nonprofit Corporation Law. It is tax exempt under Section 501 (c) (3) of the Internal Revenue Service Code. Health Research, Inc. Donors are advised to consult their own legal counsel and financial advisors for matters relating to their donations.
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