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Contribution Information

Contact Information

First Name Last Name

Street Address

Postal Code City State

Email Home Phone (Optional)

(Optional)

Employer Information

This information is required by law.

Occupation Employer

I am retired

If you are self-employed, please list the name of the entity that is on your paycheck. Please list your line of work. "Business Person" is not acceptable, please enter the type of business instead.

We respectfully request that Partners of Partnerships and Members of LLC's contribute individually, instead of through their respective business entity.

Payment Information

Card Number

Expiration Date

Remember me so that I can use FastAction next time.

Eligibility

I confirm that the following statements are true and accurate

I am not a foreign national who lacks permanent residence in the United States.
This contribution is made from my own funds, and not those of another.
This contribution is not made from the funds of a corporation or labor organization.
This contribution is made on a personal credit card or debit card for which I have the legal obligation to pay, and is not made either on a corporate or business entity card or on the card of another person.
I am at least eighteen years old.

Contributions or gifts are not tax deductible.

Federal law requires us to use our best efforts to collect and report the name, address, occupation and name of employer of individuals whose contributions exceed $200 per election cycle.

Contributions are limited to $3,300 per individual per election. The primary and general elections are separate elections, so individuals may give up to a total of $6,600 for both elections.

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