General Fund

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 Putnam Republican Town Committee. 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.

Are you currently employed?

YesNo

Employer Name*

Principal Occupation

Employer: If multiple employers and one is a state contractor, list the state contractor. If self-employed, provide Job Description. (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?*

YesNo

If no ($30.00 maximum)

Are you a communicator lobbyist?*

YesNo

If yes, ($100.00 max contribution)

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

YesNo

If yes, ($100.00 Max Contibution)

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

YesNo

If yes, please indicate which branch or branches of government the contract(s) is with

Executive, Legislative or Both branches*

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

Requirement*

I hereby certify and state that all the of the information disclosed by me and set forth above on this Contribution 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 on 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

https://seec.ct.gov/Portal/data/forms/SampleForms/definition_of_terms_party_committee_01042016.pdf

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