subject_line
I would like to contribute the following amount (limit $250 per person per election):
*
$250
$100
$50
$25
Other (Please specify)
Other Amount:
Event:
Contact Information (required)
Title
Mr.
Mrs.
Ms.
Dr.
First Name
*
Middle Initial
Last Name
*
Street Address
(we must have a street address even if your mailing address is a PO Box)
*
Address Line 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip/Postal Code
*
Phone Number
*
Email Address
*
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 "Phil Graham for Encinitas City Council 2016
" and mail it to 7185 Navajo Road Suite P, San Diego, CA 92119.
I'm sending a check
I'm using a credit card - see information below:
Name on Card
*
Credit Card Type
Visa
MasterCard
American Express
Discover
Credit Card Number
*
Expiration Date (mm/yy):
*
Contribution Type
*
Personal
Business
Paid for by Phil Graham for Encinitas City Council 2016
7185 Navajo Road Suite P
San Diego CA 92119
FPPC ID #
1385489
Contributions are not deductible for Federal income tax purposes as charitable expenses.
The maximum contribution is $250 per person per election. Individuals, businesses and PACs may contribute.
Powered by
Report abuse