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Click on small black arrows to the right of candidate's name for pull-down list of candidates

Required fields are in red. Please enter your name and address as it appears on your credit card statement.
Candidate:

Ms.   Mrs. Mr.   Dr.  
First Name:
Last Name:
Address:
City / State / Zip:
Country:
Email:
Telephone:
( ) -
Business Telephone:
( ) -
Fax:
( ) -
Contribution Amount:
$

 

 

 

 

 

 

 

 

 

 


I want to charge my contribution to my:
Master Card
Visa

Card Number: (no spaces or dashes)
Expiration Date:
Federal election law requires political committees to report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200.

Occupation:
Employer:

According to the law, JAC cannot accept corporate contributions. Membership, gifts, or other payments to JAC are not deductible as charitable contributions for federal income tax purposes.
This certifies that I have read these legal requirements.


all content copyright 2010, Joint Action Committee for Political Affairs
email: info@jacpac.org
photos by Robert A. Cumins