Balkcom for Congress

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This form only accepts US addresses.

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Requirement

The Federal Election Commission requires that all of these statements are true for anyone contributing to the campaign.

• I am a US Citizen or Permanent Resident

• I am donating my own money

• I am not under contract to the Federal Government

• I am not making this contribution in the name of another person

• I am 18 years of age or older

Joint Contribution Information:

Please provide the full name, employer and occupation for any joint donor from a joint account.

PAC Information

For any contribution from a PAC, please provide the registered PAC name and FEC ID number below:

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