Mike France 2026

Email*

Send me updates by email(not needed for receipts)

Phone

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* By providing your phone number, you are consenting to receive text message updates, including automated text messages, to that number from Mike France 2026. 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.

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

YesNo

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

YesNo

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

Age AGE (Please see restrictions regarding contributions from minors)*

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

Are you a communicator lobbyist, OR the spouse or dependent child of a communicator lobbyist?

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 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 from my personal funds, is not being reimbursed in any manner, is not being made as a loan, and is not an otherwise prohibited contribution. I certify that I have provided my residential address.

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