TEPAC Contribution Form

TEPAC

Enclosed is my check made out to TEPAC in the amount of:

___ $100 ___$75 ___$25 ___$15 ___$( )

Please include this contribution toward my club pledge:

__Benefactor ($500 Annual Contribution)
__President's ($250 Annual Contribution)
__Century Club ($100 Annual Contribution)
__Congressional Club ($50 Annual Contribution)
__Champion Club ($25 Annual Contribution)

Please send coupon and check addressed to :

TEPAC
National Treasury Employees Union
901 E. Street, N.W.
Suite 600
Washington, D.C.
20004


To comply with federal
law, we must use our best
efforts to obtain, maintain
and submit the name, mailing
address, occupation and name
of employer of individuals
whose contributions exceed
$200 per calendar year.

(Contributions are not deductible as charitable contributions for federal income tax purposes.)

03/01

_______________________________
Name
_______________________________
Address
_________________             ________          ________
City                                           State                  Zip
_______________
Social Security #
_________                              _______________________
Chapter #                                  Job Title

Please charge my contribution to my:
___Visa ___MasterCard ___American Express
Name as it appears on card __________________________
Card# ____________________ Expiration date: _________
Signature _______________________

Billing Address:
_______________________________
Address
_________________ ________ ________
City State Zip
_______________
Telephone #

You can also give through payroll deductions.
Call NTEU at 202-783-4444