ph: 586-727-2465
fax: 586-727-9055
alt: 586-531-3304
eiseninc
Please print this page, fill in info and send, thanks
Name_______________________________________ Date___________
Address _________________________________
City/ Twp. ________________________________ ZIP_______________
Phone ________________________ email_________________________
Occupation _______________________
Please Make Check Payable to : Gary R. Eisen CTE
We can accept Donations up to $1,000.00. Personal checks only....
Donation amount $_____________ Check #_____________
Send to: Gary R. Eisen CTE 6350 Rattle Run St. Clair Twp. MI 48079
Thanks for helping to KEEP the Majority..
If this page does not print, please add the above info with Check.
Thank Again for your Support.
Copyright 2016 Gary R. Eisen. All rights reserved.
ph: 586-727-2465
fax: 586-727-9055
alt: 586-531-3304
eiseninc