Harrison EMS Online Donation Form

Harrison EMS Donation Form

As an approved New York State Non-Profit Organization, a donation to Harrison Emergency Medical Services not only benefits you and the local community in terms of our quality of care, experienced staff, and scope of services, but you can write off any donations against your taxes.
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Leave a message (optional)
You can make a one-time donation or make it a reoccurring donation through our PayPal account:

$ Examples:
- $10
- $20
- $50
- $100
- $500
- Custom Amount
Donation Amount*

prevnext( X )
USDPlease enter your donation amount
Other Donation Options:

Personal or business checks may be made payable to Harrison EMS.

Mail your donation to:

Harrison EMS

PO Box 68

Harrison, NY 10528

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Card Expiration

Security Code

Please click one of the PayPal options to complete payment and submit the form.

Harrison EMS Donation Form