1. First Name *
2. Last Name *
3. Address*
4. City *
5. State * --Select-- ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING
6. Zip *
7. Phone
8. Email *

1. Federal regulations require that contributors provide their employment information. If you are not employed, enter none in the employer box and "unemployed," "retired," "homemaker," etc., in the occupation box.

2. Employer *
3. Occupation *
4. How much can I donate?

   An individual may donate a maximum of $2,300 per election (the primary and general are separate elections), so an individual may give a total of $4,600 for both elections. Even though independent candidates are not elected in primaries, federal law requires independent campaigns to designate donations as primary or general election funds. By submitting your donation, you agree that the first $2,300 of your donation is designated for the 2008 primary fund and that any further amount up to an additional $2,300 is designated for the 2008 general election fund. Each spouse may donate up to $2,300 per election. Your donation is not tax-deductible for federal income tax purposes.

1. $10 $25 $50 $100 $250 $500 $1000 $2300 $4600 Other
2. Amount
3. I would like to make this contribution:

   Once Monthly, for the next months (what's this)

1. Card type * -- Visa Mastercard American Express Discover
   
2. Card Number *
3. Expires * 01 02 03 04 05 06 07 08 09 10 11 12 -- 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 --
4. Security Code *

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1. This donation is not being provided to me by
another person or entity.

2. This donation is not made from the general treasury funds
of a corporation, labor organization or national bank.

3. I am not a federal government contractor (employees
of federal contractors may contribute).

4. I am a United states citizen or a lawfully-admitted permanent resident.

5. I am at least 16 years of age.

6. This donation is made on a personal credit or debit card for
which I have the legal obligation to pay, and is made neither
on a corporate or business entity card nor on the card of
another.