Halloween 2026

Wednesday, October 28

Halloween 2026

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Email*

Phone*

First name*

Last name*

Are you currently employed?

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Employer Name*

Principal Occupation*

Employer: If multiple employers and one is a state contractor, list the state contractor. If self-employed provide Name of Business. (Example: Dave's Painting. Other examples: Retired, Unemployed, Student, Homemaker.) Principal Occupation - If self employed, provide job Description (Example: Painter Other Examples: Retired, Unemployed, Student, Homemaker)

Is contribution being made from the account of a sole proprietorship?*

If yes, and name is different than individual contributor, list NAME OF SOLE PROPRIETORSHIP

Age (Please see restrictions regarding Contributions from Minors)*

Are you a communicator lobbyist, OR the spouse or dependent child of a communicator lobbyist? (Communicator lobbyists may not make contributions to General Assembly candidates during the legislative sessions.)*

If yes, are you an elected public official?*

Are you a principal of a state contractor or prospective state contractor? If yes, please indicate which branch or branches of government the contract(s) is with.*

If you answered “yes” to the previous question, are you an elected public official?*

Are you a principal of a holder of a valid prequalification issued by the Commissioner of Administrative Services?Select*

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Requirement*

I hereby certify and state that all of the information disclosed by me and set forth above on this contributor card is true and accurate to the best of my knowledge and belief.

I certify that I have provided my business address.

I certify that I am NOT a principal of a state contractor or prospective state contractor.

I certify that I am either a United States citizen or a foreign national with permanent resident status in the United States.

I certify that this contribution is being made using a business credit card.

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