Pine Tree Results PAC

Other

Email*

Phone*

First name*

Last name*

Middle name

Suffix

Address*

Apt, Unit, etc.

City*

State*

Zip*

This form only accepts US addresses.

Are you currently employed?

YesNo

Employer Name*

Occupation*

If donor is an organization, please provide the organization name

Type of organization

If the organization is a partnership or LLC/LLP treated as a partnership, please provide partner names and contribution allocations.

Requirement*

I am at least 18 years old and I make this contribution voluntarily.
I am a U.S. citizen or I have permanent resident alien status (i.e., I hold a “green card”).
I am making this contribution with my own funds, or with my own credit/debit card, and the funds are not advanced or reimbursed by any other person or organization.
The contributor is not a federal government contractor.
If the contributor is an organization, it is a U.S. domestic organization and not a foreign organization.
I understand that Pine Tree Results PAC is an independent organization that makes independent expenditures in connection with elections and is not affiliated with any candidate.
I understand that federal law requires Pine Tree Results PAC to collect and report the name, address, employer and occupation of individuals contributing over $200 in a calendar year.
If the contributor is a LLC or partnership, I agree to provide information regarding attribution of the contribution to individual members/partners.
Contributions from foreign nationals and federal government contractors are prohibited.
Contributions are not tax deductible.