NACUSO Advocacy Fund Pledge Posted August 19th, 2015 by Tony Muka. Organization Name* Representative's Name* Date MM slash DD slash YYYY Contact Phone #* Email Address* On behalf of the credit union, CUSO or other organization named above, I verify that our organization will pledge the sum indicated to the NACUSO Advocacy Fund. If possible, we are asking for a two-year commitment. We understand that if applicable, NACUSO will invoice for the 2nd year's amount one year from initial pledge date. Pledge Level* Platinum $25,000/year Gold $10,000/year Silver $5,000/year Bronze $2,500/year One-Time Pledge One-Time Pledge Amount One Time Pledge Amount* Comments/OtherRemain Anonymous If anonymity of the contribution is important to your organization please check this box Payment Method* Visa / MasterCard / AMEX Mail a Check Preset Pledge LevelYou have elected to pay by check. Please print the next page or your confirmation email, and send it along with your check or money order payable to NACUSO Advocacy Fund, to: NACUSO Attn: Advocacy Fund 6000 28th Street SE #300 Grand Rapids, MI 49546 Pay by Visa/MasterCard/AMEX American ExpressMasterCardVisaSupported Credit Cards: American Express, MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Credit Card Billing Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Total Pledge $0.00 CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. Δ
