By completing the information on this form, I confirm the statements below are true and accurate:
1) I am a United States citizen or a permanent resident alien.
2) I am donating $1,000 or less per person, which is defined as an individual or a corporation, association, firm, partnership, joint venture, Joint Stock Company, club, organization, estate, trust, business trust, syndicate or other combination of individuals having collective capacity.
I agree to to be contacted by phone including pre-recorded messages, SMS and/or emails, at the phone number(s) and email address provided above, from Dale Holness Campaign.
Please note: the maximum contribution allowed is $1,000.00.
Contributions to the Dale Holness Campaign are not deductible for federal income tax purposes.