EAST TEXAS CRISIS CENTER

Thank you so much for your support! 

To donate by mail, please print out this page, fill it out completely and mail to:

East Texas Crisis Center

P.O. Box 7060

Tyler TX 75711

DONOR INFORMATION                                     Date:  _____________________
 

Name: ______________________________________________________________

Address: ____________________________________________________________

City: ______________________   State: ____________ Zip: ___________________

Phone Number: _______ - _______ - ____________ 

Email Address: __________________________________

PAYMENT OPTIONS

Check Enclosed: $___________

--------- or ---------

VISA ______          MasterCard ______

Card Number: ____________________________________  Exp Date: ____________

Please accept my one time credit card donation of: $___________

Signature: ________________________________________________

----------- or ----------

Bill Me:   $_______Quarterly  or  $_______Monthly  or  $_______ Annually 

Beginning (Date): __________                Ending (Date):_______________

Levels of Giving:

Diamond: $10,000 and above            Platinum: $5,000 to $9,999
Gold: $3,000 to $4,999                     Silver: $2,000 to $2,999
Bronze: $1,000 to $1,999                  Patron: $500 to $999 

Ambassador: $250 to $499               Sustainer: $100 to $249

Friend: Up to $99