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title and name of employer. If self-employed, provide us with the name of your
business and your title. If none of the above apply, indicate if you are
unemployed, retired, or a homemaker. Thank you!
Your credit card verification code (CVC) is a 3 or 4 digit number. It can be found on the back of your card.
1. I am at least
eighteen years old.
2. I am a U.S. citizen
or lawfully permanent resident (i.e., green card holder).
3. This contribution is
made from my personal funds. Funds are not being provided to me by another
person or entity for the purpose of making this contribution.
4. I understand that it
is unlawful for a contributor to be reimbursed by an individual, organization,
business or similar entity for a contribution.
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