 |
Fill out this
form and make your check/money order payable to: |
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| Please complete the following information to comply with **election laws. |
| Name ____________________________________________________ |
| Street Address _____________________________________________________________ |
| City, State & Zip _________________________________________________ |
| Home Telephone ________________________ Work Telephone ________________________ |
| E-mail Address ________________________________________________________________ |
| I want to Support Bruce! |
| Please accept my contribution of: |
|
( ) $25, ( ) $50, ( ) $100, ( ) $250, ( ) $500, ( ) $1000, ( ) Other ___________ |
| Occupation **________________________________ Employer ** ________________________________ |
|
** Required for
contributions of $100 or more. Retired, homemaker or "none" is O.K.
for occupation. If self-employed, provide name of business. |
| _____ Check here if it is O.K. to use your name publicly as a supporter. |
| Complete this section if you wish to pay by credit card. | ________Visa ________M/C |
| Card # ___________________________________________ | Expiration Date ____________________ |
| Name as it appears on card __________________________________________________________ | |
| Signature __________________________________________________________ | |
| I am also able to help by: | ( ) displaying a yard sign. |
| ( ) distributing campaign materials at events. | |
| ( ) walking my neighborhood or precinct. | |
| ( ) hosting a fundraiser. | |
| ( ) other. |