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First Name
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Last Name
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Address
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State
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Zip
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Email
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Phone
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Federal law requires our best efforts to obtain, maintain, and report the name, address, occupation, and employer of any individual
who contributes more than $200 in an election cycle.
If not employed, enter "none"
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Employer
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Occupation
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Note: Contributions are not deductible as charitable contributions for federal income tax purposes.
An individual may contribute up to $2,400 for the primary election and up to $2,400 for the general election.
Federal multi candidate PACs may contribute up to $5000 for each election. Contributions from corporations, labor unions,
federal-government contractors, and foreign nationals (non-green card holders) are prohibited.
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By checking this box, I confirm that the following statements are true and accurate:
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- This contribution is made from my own funds, and not those of another.
- This contribution is not made from the general treasury funds of a corporation, labor organization or national bank.
- I am not a foreign national who lacks permanent resident status in the United States.
- I am at least 18 years of age.
- This contribution is made on a personal credit or debit card for which I have the legal obligation to pay, and is made neither on a corporate or business entity card nor on the card of another.
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