Donation Form Tom Del Beccaro .pdf

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Original filename: Donation Form Tom Del Beccaro.pdf
Author: Dran

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Donation Form Tom Del Beccaro.pdf (PDF, 93 KB)


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Yes! I would like to help
Elect Tom Del Beccaro to US
Senate and Replace Boxer!
My Contribution:
$2,700

$1,000

$500

$250

$100

$50

OTHER

I/We would like to make the maximum contribution. ($5,400
per person/ $10,800 per couple)
I/We would like to contribute $__________________________
Pay by check made out to “Del Beccaro for Senate”
Please charge to my credit card $______________ to my:

MasterCard

Visa

American Express

Credit Card # _______________________________________Exp. ________________ CCV# ____________
Address of Credit Card - City/State/Zip __________________________________________________________
ALL CONTRIBUTIONS REQUIRE PORTION BELOW TO BE FILLED OUT
Send this completed form along with your check to:

Del Beccaro for Senate, 7668 El Camino Real, Suite 104 #435, Carlsbad, CA 92009
Scan and Email to: tom@delbeccaroforsenate.com
Fax to: 925 284 2015
Please check this box
These contributions represent my personal funds and are not drawn on an account maintained by an incorporated entity.

Your Name
Address
Phone

________________________________________

_________________________

_________________________

Occupation

Signature

City_________________________ State

Fax

________________________________

_____________________________________

Spouse Signature (joint contributions only)

_________

Zip

_____________

_________________________Email Address _______________________

____________________________________

Spouse Occupation

Spouses Name _________________________________

Employer

______________________________________

Spouse Employer

Date

_________________________________

_________________________________________

_________________________________

Date

_________________________

All individuals may not contribute more than a total of $5,400 per election to the committee. Federal law prohibits contributions to the
committee from the general treasury funds of a corporation, labor organization or national bank (including corporate or other business
entity credit cards), from any person contributing another’s funds, from a federal government contractor, or from a foreign national
who lacks permanent resident status. Contributions are not deductible for federal income tax purposes.
Federal election law requires political committees to use best efforts to report the nam e, m ailing address, occupation, and name
of em ployer of individuals whose contributions exceed $200 during an election cycle.

Paid for by Del Beccaro for Senate, ID #C00573238


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