Annual Giving Form Form Organization Name * (written exactly as it will appear in print) Address * City * State * ZIP Code * Contact Person First Last E-mail Address * Telephone # * Fax # Sponsorship Level * Partner - $20,000 Benefactor - $15,000 Sustaining - $10,000 Supporter - $5,000 Collaborator - $2,500 Contributor - $1,000 Other $ ____________ Receive Invoice Via: E-Mail Mail Fax No Invoice Requested Crime Stoppers of Michigan has permission to use our company logo on their website, social media & in publications when acknowledging our company’s support? * Yes No Payment Via: * Check (Please make checks payable to: Crime Stoppers of Michigan Mail to: Crime Stoppers of Michigan 18000 West 9 Mile Road, Ste 500 Southfield, MI 48075) Credit Card Other (Please contact Stacey Kowalski for other forms of payment at: (313) 922-5000 ext. 122 or e-mail: stacey@michiganalliance.org.) Card Type (ONLY IF PAYING WITH A CREDIT CARD): Visa MasterCard Amex PayPal CashApp Card Number Expiration Date Security Code
