CA Agents and Health Insurance Professionals PAC - Online Contributions by eFundraising Connections

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$10
$25.00

Ruby
$50.00

Emerald
$75.00

Sapphire
$100

Diamond
$200
$300

Double Diamond
$500

Triple Diamond
$ Other

Please select a contribution amount

Iterations

This recurring donation will process on the 26th of every month until your subscription is cancelled.

This recurring donation will process every three months until your subscription is cancelled.

This recurring donation will process on October 26 annually until your subscription is cancelled.

Phone

First Contributor

First Name

Last Name

Company Name

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

Chapter

Comment

The maximum contribution amount is $9800.00. 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.

My credit card address is different than my home address.

CC Zip

Please select a contribution amount

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Only use the above payment option(s) for individual contributions. Contribute by credit card for corporate or couple donations

By contributing you agree to the terms and conditions.

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Please select an even decimal contribution amount if giving as a couple.

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Please input a value between $5.00 and $9800.00

Please input a value between $5.00 and $9800.00 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 $9800.00. Please reduce the number of iterations, or reduce the payment amount.

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

Please select this before proceeding

Iterations must be a number greater than 0

Total donation amount may not exceed $9800.00. 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

PayPal accepted

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Apple Pay accepted

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