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                                               8th District Republican Congressional Committee

                                                                              Contribution Form

 

Date of contribution: _________________

Please check one:

______ Personal Check

______ Business Check

 

Name: ______________________________________________________________________

Address: ___________________________________________________________________

City: _______________________________ State: __________ Zip: ___________________

Phone: _____________________________ Email: _________________________________

Employer: __________________________ Occupation: ___________________________

Required if amount is over $200.00

 

Please mail to:  8th District Republican Congressional Committee

1563 Gregory Lane

Jasper, IN 47546

 

 

Paid for by the 8th District Republican Congressional Committee  www.in8gop.org

Not authorized by any candidate or candidate’s committee.

Contributions to the 8th District Republican Congressional Committee are not tax

deductible for federal income tax purposes. Funds received in response to this solicitation

are subject to state and federal limits.  Federal law requires us to use our best efforts to

collect and report the name, mailing address, occupation and name of employer of individuals

whose contributions exceed $200 in a calendar year.

Contributions from foreign nationals are prohibited.