Wire Transfers

Wire transfers to PIH often arrive with no accompanying donor information. In order for us to identify your gift and issue a tax receipt, please provide us with the following information.

Transfer instructions will be emailed to you upon submission of this form.

Country

First Name

Last Name

Address for Acknowledgment Letter*

Address for Acknowledgment Letter*
	Address for Acknowledgment Letter*	Item weight

more items

City

State/Region/Province*

Zip/Postal Code

Phone

Name on Initiating Account

Originating Bank

Gift Value (in USD)

Gift Transfer Date

Transfer instructions will be emailed to you upon submission of this form.

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Please send donations to: Partners In Health, PO Box 996, Frederick, MD 21705-9942