(1) I am contributing my own funds to help this candidate qualify for the Democracy Voucher Program, which allows qualified candidates to receive public funds to help finance their campaign;
(2) I am a United States Citizen or a Permanent Resident alien;
(3) I am making this contribution from my own funds, and not those of another;
(4) I am making this contribution on my own personal credit or debit card, and not with a corporate or business card; and
(5) I am at least 18 years of age.