Sponsorship Inquiry

Empower Representation, Inc. provides nationwide free Social Security disability advocacy and authorized non-attorney representation. Our message is People Over Profit. There is no representation fee or percentage of benefits. Sponsorship recognition lasts 12 months beginning upon receipt of contribution and approval of recognition details. No confidential client details will ever be shown. All sponsors receive a year-end mission update. Sponsorship benefits are subject to confirmation of recognition details before publication.

Download and print Empower’s W-9

Contact name

First NameLast Name

Email

example@example.com

Organization

Website

Phone number (only for a requested sponsorship discussion; not SMS consent)

Please enter a valid phone number.Format: (000) 000-0000.

Mailing address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Annual sponsorship tier

Custom annual amount

Recognition preference

Exact recognition name

Logo upload

Optional. Upload your logo as PNG, JPG, SVG or PDF (maximum 10 MB).

I authorize Empower Representation, Inc. to use the name and logo I provide for the sponsor recognition described above. Recognition details will be confirmed before publication.

Optional message

Questions? Email info@empower-representation.com or call 833-677-0828. Privacy Policy

How would you like to send your sponsorship contribution?

Submit your sponsorship details, then continue to Empower’s secure Bluevine payment portal. Enter the amount matching your sponsorship and use the same name and email so we can match your payment. Your sponsorship is not paid until you complete payment on Bluevine. Continue to secure card payment

Make your check payable to Empower Representation, Inc. Mail to PO Box 1005, Chesterton, IN 46304. Include your sponsor/organization name and sponsorship tier so we can match your contribution. Recognition begins after payment is received and recognition details are confirmed.