Bob McEwen for Congress Contribution Form
To Contribute by Mail or By Fax: * Please answer all questions in bold.
PERSONAL INFORMATION: Title Mr. Mrs. Ms. Miss Dr. Rev. Ret. *First Name Middle Initial *Last Name Suffix Jr. Sr. III IV ADDRESS INFORMATION: *Address *City *State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia 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 Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Not USA or Canada *Zip *Phone *E-mail We are required by law to ask for the following information: *Employer *Occupation AMOUNT: I would like to make a one-time contribution of: *Amount $ Contributions or gifts to the McEwen for Congress Committee are not deductible as charitable contributions for federal income tax purposes. CREDIT CARD INFORMATION: (NOTE: if paying by check, attach your check made payable to the McEwen for Congress Committee. For your protection: The address you provide should be the same as the billing address of your Credit Card. *Card Type: *Credit Card# *Expiration Date 01 02 03 04 05 06 07 08 09 10 11 12 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Please verify the information below: By checking this box, I acknowledge that contributions from corporations and foreign nationals are prohibited. FAX TO: When you have completed this form, please print this page and FAX it to: 1-800-786-8740 or MAIL TO: Bob McEwen for Congress PO Box 115 Batavia, Ohio 45103 Paid for by the McEwen for Congress Committee. Funds received in response to this solicitation will be subject to federal contribution limits.Contributions from corporations and foreign nationals are prohibited.For contributor assistance please email info@mcewenforcongress.com
PERSONAL INFORMATION:
Title
Mr. Mrs. Ms. Miss Dr. Rev. Ret.
*First Name
Middle Initial
*Last Name
Suffix
Jr. Sr. III IV
ADDRESS INFORMATION:
*Address
*City
*State
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia 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 Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Not USA or Canada
*Zip
*Phone
*E-mail
We are required by law to ask for the following information:
*Employer
*Occupation
AMOUNT:
I would like to make a one-time contribution of:
*Amount
$
Contributions or gifts to the McEwen for Congress Committee are not deductible as charitable contributions for federal income tax purposes.
CREDIT CARD INFORMATION: (NOTE: if paying by check, attach your check made payable to the McEwen for Congress Committee.
For your protection: The address you provide should be the same as the billing address of your Credit Card.
*Card Type:
*Credit Card#
*Expiration Date
01 02 03 04 05 06 07 08 09 10 11 12 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Please verify the information below:
By checking this box, I acknowledge that contributions from corporations and foreign nationals are prohibited.
FAX TO:
When you have completed this form, please print this page and FAX it to: 1-800-786-8740
or
MAIL TO:
Bob McEwen for Congress PO Box 115 Batavia, Ohio 45103