Thursday, September 11, 2014

Contribution Form for the Vote Vance Congressional Committee

Federal law requires us to report the name, address, occupation, and name of employer of each contributor whose contributions exceed $200 in an election cycle. Individuals may contribute a maximum of $2,600 for the general election. Multi-candidate PACs may give a maximum $5,000 for the general election. Contributions from corporations, labor unions, foreign nationals, and federal government contractors are prohibited. Contributions are not tax deductible for federal income tax purposes.

Please Print:

Prefix First name Middle Initial Last name Suffix


Street Address ___________________________________________________________


State ___________________________________ zip code ________________________

E-mail address ___________________________________________________________

Phone number ___________________________________________________________

[__] Check this box if you are Retired.

Employer _______________________________________________________________

Occupation ______________________________________________________________

[__] By checking this box, I confirm that the following statements are true and accurate.

* I am a United States citizen or a permanent resident alien.
* I am making this contribution from my own personal funds, and not those of another.
* I am not a federal contractor.
* I am making this contribution on my own personal checking account and not with a
   corporate or business checking account or a checking account issued to anyone else.
* I am at least 18 years of age.

Make checks payable to: Vote Vance
Mail to: Vote Vance, 633 E. North 19th Street #306, Abilene, Texas 79601-3258

© Vote Vance