Contact Information (*required)

Title

First Name *

Middle Initial

Last Name *

Name of Business (if this is a business contribution)

Street Address (we must have a street address even if your mailing address is a PO Box) *

Address 2

City *

State *

Zip/Postal Code *

Phone Number *

Email Address *

If contribution is from an individual, we are required by law to obtain the following information:

Occupation

Employer (name of business if self-employed)

Contribute by Check or Credit Card

If contributing by check, please make check payable to "Citizens for a Better Palm Springs" and mail it to 74333 Hwy 111 Suite 205, Palm Desert CA 92260.

I'm sending a check

I'm using a credit card - see information below:

Name on Card

Credit Card Type

Credit Card Number

Expiration Date (mm/yy):

Contribution Type *

Personal

Business

Personal, being reimbursed by a Business

Paid for by Citizens for a Better Palm Springs

74333 Hwy 111 Suite 205
Palm Desert CA 92260
FPPC ID # 1392926

Contributions are not deductible for Federal income tax purposes as charitable expenses. There is no contribution limit. Individuals, businesses and PACs may contribute.