Page 7 - 2024 Crossroad Sponsor Packet
P. 7
Payment Form
Donor/Company Name: _____________________________________________ Contact Name: _____________________________________________________ Address: ____________________________________________________________ City/State/Zip: _______________________________________________________ Phone: ________________________ Email: _______________________________ Name to appear in the program: _____________________________________
I don't wish to be listed in printed materials.
I decline all benefits.
I'm unable to attend the event. Please donate my table to a partner.
Sponsorship Level: _________________ Sponsorship Amount: $_____________
Payment Form:
Visa MasterCard AmEx
Name as it appears on card: __________________________________________ Credit Card Number: ________________________________ Exp. Date: _______ Security Code: ______________________ Zip Code: ______________________ Signature: _____________________________________________________________
Please make checks payable to: Crossroads Community Services Mail to: Crossroads
Attn: Cynthia Thompson 4500 S. Cockrell Hill Rd Dallas, TX 75236
FOR MORE INFORMATION CONTACT CYNTHIA THOMPSON CThompson@CCSDallas.org | 469-860-6087
