NACUSO Advocacy Fund Pledge Posted August 19th, 2015 by Tony Muka. 0.0 00 Organization Name*Representative's Name*Date Date Format: 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/yearGold $10,000/yearSilver $5,000/yearBronze $2,500/yearOne Time Pledge (specify below)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 / AMEXMail a CheckPreset 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 PMB 3419 Via Lido #135 Newport Beach, California 92663 Pay by Visa/MasterCard/AMEX American ExpressMasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Security Code Cardholder Name Credit Card Billing Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Total Pledge $0.00 CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
