Support - Farmington Democratic Town Committee

Listening to Your Concerns, Governing with Transparency, Delivering Results

We need your help to ELECT DEMOCRATIC CANDIDATES

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Email*

Phone

First name*

Last name*

Middle name

Residential Address*

Apt, Unit, etc.

City*

State*

Zip*

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Principal Occupation*

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Are you a Communicator Lobbyist? If so your donation may not exceed $100.00 for a calendar year.*

NY

Are you the spouse or dependent child of a communicator lobbyist"*

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Are you a State Contractor or Prospective State Contractor (including spouse and dependent children)*

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If you are a state contractor or prospective state contractor, are you an elected public official?

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

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I certify that I am either a United States Citizen or a Foreign National with Permanent Resident Status in the United States.*

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I certify that I have provided my residential address and that I am 18 years of age or older.*

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 otherwise a prohibited contribution.*

Personal Credit Card

I want to display a yard sign from October to Election Day?

Display Yard Sign

I want to be a volunteer to help with our campaign!

I want to be a volunteer to help with our campaign!

Scholarship

Scholarship amount MUST be entered in the Scholarship Field. If not none of the donation will go towards the Scholarship Fund.

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Exp. Date*

CVC / CVV*

Zip*

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Total donations for a calendar year may not aggregate to more than $2000.00.

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Thank you for supporting the work of the Farmington Democratic Town Committee

Paid for by Farmington Democratic Town Committee, Matthew Hutvagner, Chairman

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