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USPAACC Wisconsin Chapter
1915 N Martin Luther King Dr, Suite 213Milwaukee,WI 53212
414-267-2488 (Phone) 414-267-2489 (Fax)
www.USPAACC-wi.comritus@USPAACC-wi.com
APPLICATION FORM
Select An Option
Minority Business-$75.00/Year
Non-ProfitOrganization-$25.00/Year
Student-$15.00/Year
User Name
Password
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Name
Company
Title
Phone
E-Mail
ASIAN-AMERICAN SCHOLARSHIP FUND
Yes I would like to make a contribution
No Not at this time
$
Amount(If You Answered Yes)
Contributions are tax-deductible under IRS Code 501 (c)
PAYMENT METHOD
Company / Personal CheckCheck #Check Payable to: USPAACC Total Amount:$
Credit Card
Visa
Master Card
American Express
Card#
Name of Cardholder:
Authorized Signature:
Charged Amount:
PLEASE SEND COMPLETED APPLICATION TO THE ABOVE ADDRESS
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WISCONSIN
U.S. Pan Asian
American
Chamber of
Commerce
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