Credit Card Donation Form

Please accept my personal credit card for payment in the amount specified below in support of the Washtenaw County Democratic Party. (VISA, M/C or Discover). I understand that my contributions are not U.S. tax deductible.

Donation amount: $

Name on card:

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Credit Card #:

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CVV2 Code:

Expiration:

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E-mail Address:

(Your e-mail address will only be used to communicate with you about this transaction.)

Street Address:

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City:

State:

Zip:

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Home Phone:

(The government requires us to collect the following information.)

Occupation:

Employer:

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Work Phone:

I am contributing for myself

I am a US citizen or permanent resident

I am not, nor do I work for a Federal contractor

Please select from the following:

Notes regarding this donation:

Paid for by the Washtenaw County Democratic Committee. Your contribution may be used in connection with federal elections and is subject to the limitations and prohibitions of the Federal Election Campaign Act. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and employer of individuals whose contributions exceed $200 in a calendar year. This communication is not authorized by any candidate or candidate's committee.

Please use the above contact info to update the WCDP Members List

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2007 Annual Dinner