Thank you for your Contribution!

NAME OF INDIVIDUAL CONTRIBUTOR (LAST NAME, FIRST NAME, MIDDLE NAME)

Is contribution being made from the Account of a sole proprietorship?
If yes, and name is different than individual contributor, list NAME OF SOLE PROPRIETORSHIP

RESIDENTIAL ADDRESS

Please mark if you are UNDER 18

EMPLOYER

Please review the definitions and answer each of the following:

Are you a Federal Contractor?
Are you a Foreign National?

CERTIFICATION

I hereby certify and state that all of the information disclosed by me and set forth above on this contributor card is true and accurate to the best of my knowledge and belief. I certify that I am NOT a principal of a federal contractor or prospective federal contractor. I certify that I am either a United States citizen or a foreign national with permanent resident status in the United States. I certify that this contribution is being made from my personal funds, is not being reimbursed in any manner, is not being made as a loan, and is not an otherwise prohibited contribution.

Electronic Signature

Date

Contributions are not deductible for federal income tax purposes The maximum an individual may contribute is $2,700 per election, with the primary and general elections treated separately As a result, any initial contribution up to $2,700 per person. A couple may contribute $10,800, designated per person in accordance with the proceeding sentence. Federal multi-candidate PACs may contribute $5,000 for the primary and $5,000 for the general. Contributions from corporations, labor organizations, federal government contractors, and foreign nationals without permanent residency status (“green card”) are prohibited.