Business Partner Application

Business Partner Application

KS License #CB001XWJ | 501(3)(c) #01-0865151
WWW.LCHSinc.org | 100 W. Gilman Road, Lansing, KS. 66043

LvnCoHS@live.com | (913)-250-0506 | @LvnCoHumane
Business Partner Tier (check one):

Friend (Tier 1) - $500+ Contribution Per YearSupporter (Tier 2) - $1000+ Contribution Per YearAdvocate (Tier 3) - $2500+ Contribution Per YearChampion (Tier 4) - $5000+ Contribution Per Year
Visit www.lchsinc.org/business-partner to view more about each tier's benefits.
Company Name:
Street Address:
City, State, Zip:
Mailing Address:
City, State, Zip:
Business Phone Number:
Website:
Facebook Handle:
Instagram Handle:
Contact Name:
Title:
Phone:
Email Address:
example@example.com
Number of Employees:
Type of Business:
If employees donate to LCHS, do you have a matching contribution program?

YesNo
If yes, how does the employee or LCHS apply?
Would your business like to become the home for an LCHS, Inc. Donation Station?

YesNo
Learn more about the LCHS, Inc. Donation Station Program here: https://www.lchsinc.org/donation-stations
Would you like a representative from LCHS, Inc to contact you with any event or additional partnership/sponsorship opportunities?

YesNo
Signature

Clear
Date

MonthDayYear
Date
Should be Empty: