Please ensure that if you are selecting your residential address from the drop down, the correct town and zip code are inputted. You can manually change them if they are not correct.

Choose Amount

This form only accepts US addresses.

Are you currently employed?

Please note: If self-employed provide Job Description. (Examples: Painter, Retired,Unemployed, Student, Homemaker). If self-employed provide the Name of Business: (Examples Dave's Painting, Retired, Unemployed, Student, Homemaker)

Review the below contribution rules before agreeing.


I hereby certify and state that all of the information disclosed by me and set forth above on this contribution form is true and accurate to the best of my knowledge and belief.


I certify that I am either a United States citizen or foreign national with permanent resident status in the United States.


I certify that I have provided my residential address.


I certify that this contribution is made on my personal debt 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 to read legal definitions:

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




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