One moment please...
How do I plan to pay
*
Payroll Deduction
Credit Card
Check
How many HIGH FIVES do you want to give?
*
$5
-
1 HIGH FIVE
$10
-
2 HIGH FIVES
$15
-
3 HIGH FIVES
$20
-
4 HIGH FIVES
$
How many HIGH FIVES do you want to give?
*
$5 - 1 HIGH FIVE
$10 - 2 HIGH FIVES
$15 - 3 HIGH FIVES
$20 - 4 HIGH FIVES
MORE?
Employee ID
*
How many HIGH FIVES?
If you chose MORE HIGH FIVES, how many would you like to give?
Who do you want to HIGH FIVE?
Name
*
First Name
Last Name
Hospital Department or Clinic
*
So that we know where to deliver your HIGH FIVE!
Other employees you want to HIGH FIVE
If you purchased more than one HIGH FIVE, tell us who to send them to and their department/ clinic.
Your Information
Name
*
First Name
Last Name
Email
*
Verify Email
*
Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Add 3% to my total amount to help cover the payment processing fees