Contribute by Mail or Fax - printable form
Print this page, fill out the support form and fax to 888-943-9797
or mail to: PO Box 3643, Seattle, WA 98124-3643.
 |
Yes! I want to contribute to help
advance free markets and make Washington a better
place to live and own a business. |
All information provided below is completely confidential
and used
for Washington Policy Center purposes only.
Levels of Support |
|
Chairman's Club |
$10,000 |
|
|
President's Council |
$5,000 |
|
Benefactor |
$2,500 |
|
|
Leadership Council |
$1000 |
|
Patron |
$500 |
|
|
Research Circle |
$100 |
|
Associate |
$50 |
|
|
Other |
$_______ |
Name |
|
Address |
|
City, State, Zip |
|
e-mail |
|
Home Phone |
|
Work Phone |
|
|
Yes! I want to be added to WPC's
e-mail list. |
|
My check
written to Washington Policy Center is enclosed |
|
Visa |
|
MasterCard |
|
American Express |
Credit
Card Number |
|
Expiration
Date |
|
Security Code |
|
Signature |
|
To have funds withdrawn from your checking account, please fill in appropriate information below. Here is an example of where those numbers are located on your check:
|
One Time Gift |
|
|
Monthly Gift |
Amount |
|
9-digit Bank Routing Number |
|
Account Number |
|
|
I (we) hereby authorize Washington Policy Center, to initiate debit entries, and to initiate, if necessary, adjustments for any entries made in error to my (our) account.
This authority is to remain in full force and effect until Washington Policy Center has received a written notice of its termination in such time and in such manner as to afford Washington Policy Center and Receiving Financial Institution a reasonable opportunity to act. |
Fax this form to 888-943-9797 or mail
to: PO Box 3643, Seattle, WA 98124-3643. |
