Windsor Democrats

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 Windsor Democrats. 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.

Country*

This form only accepts US addresses.

City*

State*

Zip*

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 Name of Business. (Example: Dave's Painting.) For occupation, provide Job Description (Example: Painter).

Please select your age:*

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

Are you an elected public official?*

Are you a principal of a state contractor or prospective state contractor? If yes, please indicate which branch or branches of government the contract(s) is with:*

Are you a principal of a holder of a valid prequalification issued by the Commissioner of Administrative Services?*

Requirement*

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

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