Orange Democratic Town Committee Donations

Choose Amount

Cover the fees

Make this a annually gift

Email*

Phone*

First name*

Last name*

Residential Address*

Apt, Unit, etc.

City*

State*

Zip*

This form only accepts US addresses.

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).

Are you 18 years of age or older?*

Are you a communicator lobbyist?*

NoYes ($100 maximum contribution)

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

Are you a principal of a state contractor or prospective state contractor?*

NoYes, ExecutiveYes, LegislativeYes, Executive and Legislative

If yes, please note which branch or branches of the government the contract is with

Are you an elected public official?*

YesNo

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

YesNo

Donation Category*

Please select the specific reason for your donation

Click to confirm these statements are true.*

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 either a United States citizen or a foreign national with permanent resident status in the United States.

I certify that this contribution is made on my personal debit or credit card for which I have a 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, is not an otherwise prohibited contribution, and that payment on this card is not made from the funds of a corporation, labor organization or any other entity.

Click here for the definitions of terms.

Card Number*

Exp. Date*

CVC / CVV*

Zip*

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

- Federal law requires us to use our best efforts to collect and report the name, address, occupation, and employer of individuals whose contribution exceeds $200 in an election cycle.

- The maximum amount an individual may contribute is $2,000 per election. Your contribution (up to $2,000) will be designated for the primary election. The next $2,000 will be designated for the general election.

- Contributions to Orange Democratic Town Committee are not tax deductible for federal income tax purposes. Contributions from corporations, labor unions, federal contractors, and foreign nationals are prohibited.

Please include your full name, address, email address, occupation and employer in the envelope.

PAID FOR BY THE ORANGE DEMOCRATIC TOWN COMMITTEE, Pat Sanders Romano, Treasurer