Indra Sen for Ridgefield

We invite you to consider a contribution to Indra Sen for Ridgefield — an exploratory committee for a municipal election in Ridgefield, Connecticut. Visit www.indrasen.com to learn more about our mission and priorities for Ridgefield.

Choose Amount

Email*

Send me updates by email(not needed for receipts)

Phone

Send me updates by text*

* By providing your phone number, you are consenting to receive text message updates, including automated text messages, to that number from Indra Sen for Ridgefield. Message & Data rates may apply, and message frequency may vary over time. Reply "STOP" to opt out of these text message updates.

First name*

Last name*

Residential Address*

Apt, Unit, etc.

City*

State*

Zip*

This form only accepts US addresses.

Age*

Name of Employer*

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

Are you a lobbyist?*

Are you the spouse or dependent child of a lobbyist?*

Do you or a business with which you are associated**** have a contract with Ridgefield that is valued at more than $5,000?*

A “business with which you are associated” refers to any business in which the contributor is a director, officer, owner, limited or general partner, or stockholder of 5% of more of the total stock of the business.

Requirement*

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.
I am of age years of 18 or older. Parents (of individuals who are under age 18 and whose minor wants to donate) can e-mail info@indrasenforridgefield.com to learn more (max contribution $30 for individuals under age 18).
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 this contribution is being made on my personal debit or credit card for which I have legal obligation to pay and intend to pay from my own personal funds, is not being reimbursed in any manner, is not being made as a loan, and is not an otherwise prohibited contribution and that payment is not made from the funds of a corporation, labor organization, or any other entity.

Card Number*

Exp. Date*

CVC / CVV*

Zip*