CONTRIBUTION FORM Name Mailing Address
CONTRIBUTION FORM Name ________________________________________________________________ Mailing Address ________________________________________________________ City, State Zip __________________________________________________________ Phone ___________________ Email _______________________________________ Occupation _________________________ Employer __________________________ Please make your check payable to:
Make DC Listen P.O. Box 131808 Houston, TX 77219-1808
For credit card contributions, please complete the information below: Name on Card _____________________________________ Amount $ ____________ Card Number __________________________ Type ______ Exp ______ Code ______ Signature _________________________________________ Date ________________ For wire contributions, please fax this form to (832) 810-0026 and wire funds to: Suntrust Bank | Routing # 061000104 | Acct # 1000178943378 Contributions to Make DC Listen are not deductible as charitable contributions for federal income tax purposes. Contributions from foreign nationals are prohibited. Federal government contractors should consult counsel prior to making a contribution to Make DC Listen. Make DC Listen is registered with the Federal Election Commission as an independent expenditure-only committee and may accept unlimited contributions from individuals, corporations, and other organizations. Contributions are not subject to FEC contribution limits. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of employer of each individual whose contributions exceed $200 in a calendar year. Make DC Listen spending is independent, and does not make contributions to, or coordinate its spending with, any candidates or political parties.
P.O. Box 131808, Houston, TX 77219-1808 | Tel (832) 810-0025 | Fax (832) 810-0026 Paid for by Make DC Listen and not authorized by any candidate or candidate’s committee. MakeDCListen.com
Make DC Listen P.O. Box 131808 Houston, TX 77219-1808
For credit card contributions, please complete the information below: Name on Card _____________________________________ Amount $ ____________ Card Number __________________________ Type ______ Exp ______ Code ______ Signature _________________________________________ Date ________________ For wire contributions, please fax this form to (832) 810-0026 and wire funds to: Suntrust Bank | Routing # 061000104 | Acct # 1000178943378 Contributions to Make DC Listen are not deductible as charitable contributions for federal income tax purposes. Contributions from foreign nationals are prohibited. Federal government contractors should consult counsel prior to making a contribution to Make DC Listen. Make DC Listen is registered with the Federal Election Commission as an independent expenditure-only committee and may accept unlimited contributions from individuals, corporations, and other organizations. Contributions are not subject to FEC contribution limits. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of employer of each individual whose contributions exceed $200 in a calendar year. Make DC Listen spending is independent, and does not make contributions to, or coordinate its spending with, any candidates or political parties.
P.O. Box 131808, Houston, TX 77219-1808 | Tel (832) 810-0025 | Fax (832) 810-0026 Paid for by Make DC Listen and not authorized by any candidate or candidate’s committee. MakeDCListen.com
