Z4C Campolo 3 11 15 Reply 02 .pdf
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MARCH 11TH, 2015
ZELDIN FOR CONGRESS CONTRIBUTION FORM
Federal Law requires us to use our best efforts to collect and report the name, mailing address, occupation and name of employer
for each individual whose contributions exceed $200 in a calendar year.
❏ Yes, I (we) will attend. Please reserve ______ tickets at $500 per person
❏ No, I (we) cannot attend, but enclosed is my (our) donation of $___________.
❏ Yes, I (we) will attend the reception as a Sponsor for the following level:
❏ Friends of Lee - $1,000
❏ Sponsor - $2,600
Enclosed you will find my contribution of: $ __________________________________________
Preferred Mailing Address:_______________________________________________________
City: _____________________________ State: _______________ Zip:___________________
Occupation: __________________________ Employer: _______________________________
Cell Phone: __________________________ Home Phone: ____________________________
Office Phone: _________________________ Fax Number:_____________________________
Please make your personal check payable to Zeldin for Congress
C/o Nancy Marks, Treasurer, PO Box 610, Shirley, NY 11967
Sorry No Corporate Checks (Personal or LLC Only)
To make your Zeldin for Congress payment by personal credit card, please complete the following information:
❏ Visa ❏ MasterCard ❏ American Express ❏ Discover
Name as it appears on card: ______________________________________________________
Card Number: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ Exp. ________ Sec Code __ __ __ __
Amount: $________ Signature:
You may also contribute through our secured website at ZeldinForCongress.com
Federal law requires us to report the name, address, occupation and name of employer of each contributor. The maximum an individual may
contribute is $2,600 for the primary election and $2,600 for the general election, for a total of $5,200. Contributions made by both spouses on
a joint check must be signed by both or their separate written authorizations. Federal multi-candidate PAC's may contribute $5,000 per election.
Contributions are not tax deductible for federal income tax purposes. Contributions by corporations, foreign nationals, and federal government
contractors are prohibited.
Not printed at government expense
Paid For By Zeldin For Congress
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