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Contribution Payment Form

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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. If you have not yet requested an authorization number, please click here.
  • Provided by the Health Research, Inc. office.
  • American Express
    Supported Credit Cards: American Express, Discover, MasterCard, Visa
  • 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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