Great Lakes Southeast Michigan Chapter Harley Owners Group

IN KIND Contribution

Please complete the information below as you would like it to appear on acknowledgement.

Date: ______________________________

Company Name: _________________________________________________________________________

Donors Name: _________________________________________________________________________

Address: _________________________________________________________________________

City State & Zip: _________________________________________________________________________

Telephone Number: _________________________________________________________________________

Fax Number: _________________________________________________________________________

E-Mail: _________________________________________________________________________

Give a brief description of items or service(s) donated: (Please include restrictions, if there are any and thank you for your generosity)

Value of donation: $ ________________________

Can we promote your website? (Print complete website address as you would like it to appear)

Mail To: Rhonda Sikora

Donations

P.O. Box 315

Eastpointe, MI 48201

For a shipping address contact Rhonda Sikora @ 586-566-7042 or email her at the following addresses: glsem@yahoo.com

GLSEMHOG is a 501C7 Michigan non-profit organization.

Your contribution toward GLSEMHOG charity projects is sincerely appreciated.

Reference: _____________________________________ Phone: ___________________________