Rachel N Hernandez Campaign Fund - Online Contributions by eFundraising Connections

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Iterations

This recurring donation will process on the 24th of every month.

Phone

First Contributor

First Name

Last Name

Company Name

True

Responsible Officer First Name

Responsible Officer Last Name

PAC Name

PAC ID

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 $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.

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Please input a value between $10.00 and $5500.00

Please input a value between $10.00 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 merchandise 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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