Pat Bates for Supervisor 2022 - Online Contributions by eFundraising Connections

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Iterations

Phone

First Contributor

First Name

Last Name

Company Name

Company Type

Responsible Officer First Name

Responsible Officer Last Name

I agree to the following statements:

Responsible Officer is the Name of Individual with Primary Responsibility for Approving this Contribution

Second Contributor

First Name

Last Name

Joint Address

Address

City

State

Zip

First Contributor

I am retired

Employer

Occupation

If you have no occupation or employer, do not leave blank. For occupation use general terms such as 'manager', 'homemaker', or 'none.' If not employed by a company, use terms such as 'self', 'retired', or 'unemployed.'

Second Contributor

I am retired

Employer

Occupation

Comment

The maximum contribution amount is $4400.00. Please lower your contribution amount.

Credit Card Number

MM/YY

Security

CVC on Visa/MasterCard/Discover is a 3 digit code on the back of the card. CVC on AMEX is a 4 digit code on the front of the card.

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Please input a value between $25.00 and $4400.00

Please input a value between $25.00 and $4400.00 or select "I want to donate as a couple" to double the contribution limit.

Iterations may not exceed 32000

Total recurring amount plus merchadise may not exceed $4400.00. Please reduce the number of iterations, or reduce the payment amount.

Time span must not be past credit card's expiration date

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Iterations must be a number greater than 0

Total donation amount may not exceed $4400.00. Please reduce the number of iterations, or reduce the payment amount.

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Number of Weeks

Number of Months

Number of Quarters

Number of Years

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