PATRICK LEE GIPSON 4 ASSEMBLY 2024 - Online Contributions by eFundraising Connections

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I want to donate as a couple

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Iterations

This recurring donation will process on the 23rd of every month.

Phone

First Contributor

First Name

Last Name

Company Name

Company Type

PAC ID

True

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 are retired, please put: Occupation: Retired, Employer: None

If you are unemployed, please put: Occupation: Unemployed, Employer: None

If you are a stay-at-home parent, please put: Occupation: Stay-at-home parent, Employer: None

If you are self-employed or an independent contractor and do business under your first and last name, please put: Occupation: <describe your business>, Employer: First and Last Name

If you are self-employed and do business under a business name, please put: Occupation: <describe your business, i.e., "photographer">, Employer: The name that people put on checks to your business, i.e., "Jake's Discount Photography"

If you are employed by a company, please put Occupation: <describe your job title, i.e., "Director of Sales">, Employer: <the name of your employer>.

Second Contributor

I am retired

Employer

Occupation

If you are retired, please put: Occupation: Retired, Employer: None

If you are unemployed, please put: Occupation: Unemployed, Employer: None

If you are a stay-at-home parent, please put: Occupation: Stay-at-home parent, Employer: None

If you are self-employed or an independent contractor and do business under your first and last name, please put: Occupation: <describe your business>, Employer: First and Last Name

If you are employed by a company, please put Occupation: <describe your job title, i.e., "Director of Sales">, Employer: <the name of your employer>.

Comment

The maximum contribution amount is $5500.00. 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

Routing Number

Account Number

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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 $5500.00

Please input a value between $5.00 and $5500.00 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 $5500.00. 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 $5500.00. 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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Apple Pay accepted

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