Help Support TransWeb: donation form

Thank you for supporting TransWeb!

Please print this form and send it with your donation to the address at right. If you have any questions, please don't hesitate to call 734-998-7314 or email transweb@umich.edu.	TransWeb Northern Brewery Building 1327 Jones Dr., Suite 105 Ann Arbor, Michigan 48105
Donations to TransWeb, as part of the University of Michigan, are fully deductible for U.S. federal income tax purposes, subject to the limitations placed on charitable gifts. For residents of the State of Michigan, these gifts also qualify the donor for a state tax credit.

A. Person making the donation:	B. Send the gift acknowledgement to (if different from A):
Name:___________________________________	Name:___________________________________
Address: _________________________________	Address: _________________________________
City: ____________________________________	City: ____________________________________
State: __________________ ZIP: _____________	State: __________________ ZIP: _____________
Country: _________________________________	Country: _________________________________
Daytime phone: (_____) __________________	Daytime phone: (_____) __________________
Fax: (____) ___________________	Fax: (____) ___________________
E-mail: __________________________________	E-mail: __________________________________
Web address: _____________________________	Web address: _____________________________

C. Amount of donation			D. Method of donation
	___ $1,000	___ $75		____ Enclosed is my check or money order (made payable to The University of Michigan, and write "TransWeb" in the memo line)
	___ $500	___ $50
	___ $250	___ $25		____ Charge my gift to:	____ Visa
	___ $100	___ $10			____ Mastercard
	___ Other (please specify: $________)			__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
	___ Other (please specify: $________)			Expiration date: __ __ / __ __
				Signature: ________________________________________
				Print cardholder's name as it appears on the card:
				________________________________________

E. Acknowledgement All gifts will be acknowledged by letter and noted on the site sponsors' page. If your gift is made in honor of someone, or in memory of someone, this will also appear.
(check one) ____	This gift was made in memory of: _________________________________________
____	This gift was made in honor of: ___________________________________________
____	I would prefer that my gift remain anonymous.

Thank you very much for your help!

Last modified: 11 May 2000