Support DRTC — Anedot

Use Your DonorID (optional)

Phone

Name

First

Last

Residential Address

Street Address

Apt.

City

State

Zip

I am retired

Employer

Principal Occupation

In support of (optional candidate name): Are You A Communicator Lobbyist Or The Spouse Or Dependent Child of a Communicator Lobbyist? I Hereby Certify That All Of The Information Disclosed By Me And Set Forth Above On This Contributor Form Is True And Accurate to the Best of My Knowledge and Belief I Certify That I Am Not A Principal Of A State Contractor Or Prospective State Contractor (See Definition Of Terms Link Below) 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 I Have Provided My Residential Address And That I Am 18 Years Of Age Or Older. I Certify That This Contribution Is Made On My Personal Credit Card For Which I Have A Legal Obligation To Pay And Intend To; it is not being reimbursed in any manner, and is not being made as a loan, and is not an otherwise prohibited contribution. Are you a Principal of a Holder of a Valid Prequalification Issued by the Commissioner of Administrative Services?

Card Number

Exp. Date

CVC

ZIP / Postal

Your card code is incomplete. Your card code is invalid. Your card code is missing. Your expiration date is incomplete. Your expiration date is missing. Your expiration date is in the past. Your card number is incomplete. Your card number is invalid. Your card number is missing. Your billing ZIP is incomplete. Your billing ZIP is missing.

Bank Routing Number (9 digits) Bank Account Number (4-17 digits)

Bank Account Type

Business Personal

Checking Savings Checking Savings

Complete your donation below using PayPal.

By accessing this form you agree to the
Terms of Service and Privacy Policy.

DRTC

Sign in to save time donating

Donations Secured by Anedot