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 Stevens for Justice. 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*

Middle name

Title

Suffix

Residential Address*

Apt, Unit, etc.

City*

State*

Zip*

This form only accepts US addresses.

Are you currently employed?*

YesNo

Employer Name*

Occupation*

Requirement

I certify that the following statements are true and correct:

• This contribution is made from my own funds and not those of another.

• This contribution is not made from the general treasury funds of a corporation, business entity, NC registered Lobbyists, labor unions professional association, or insurance company.

• This contribution is made on my personal credit card for which I have a legal obligation to pay and is not made on a corporate credit card.

Joint Contribution Information Required:

If this is a joint contribution from a joint personal account, please list the joint contributor information below. Required information: Full name, address if different from above, employer and occupation.

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