Printable Form
Please print, complete and return this form to ISCA.

1. Amount: 
[ ] Yes! I would like to support the Islamic Supreme Council's efforts to educate government and the media about Islam.

I would like to donate:
[ ] $10     [ ] $25     [ ] $50     [ ] $100     Other $______________

2. Form of payment: 
a) [ ] I have enclosed a check (please make checks payable to Islamic Supreme Council of America) 
b) [ ] Please charge my credit card: 
Credit card number: ________________________________________________________
Exp. Date:________________
Name as it appears on the card: _______________________________________________________________________ 
Billing Address: ____________________________________________________________________________________

[ ] I would like to make this donation on a monthly basis (for check donations, please include a voided check).

Signature: _____________________________________________________ 

c) or: You may wire funds directly to:
Islamic Supreme Council of America, Routing #072401682 Acct #7517569534 Old Kent Bank - Central. 
123 Washington St, Owosso MI 48867, ph. (517) 723-8822.

3. Supporter:
[ ] Yes, I would like to encourage the Islamic Supreme Council of America, but I am unable to donate at this time. Please add my name to your list of supporters.

4. Contact Information: 
Please print legibly.

Name: _________________________________________

Address: ________________________________________

City: ____________________ State: ____ Zip:__________

Telephone: ______________________________________

Fax: ___________________________________________ 

Email: __________________________________________

Please return this form to: ISCA, PO Box 44410, Detroit MI 48244-9929