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Your Information
*First Name
*Last Name
*Email Address
*Please check this box to confirm the following statements are true:
1. I am a United States citizen or an individual lawfully     admitted with permanent residence status (e.g., a "green     card holder")
2. This contribution is made from my own personal funds     and is not made from the general treasury funds of a     corporation, labor organization, or national bank
3. I am not a federal government contractor
4. This contribution is made on a personal credit card and     not a corporate credit card or the credit card of another     person



Additional Information

Individuals may make maximum contributions of $2,300 to the primary election and $2,300 to the general election. Married couples can donate a maximum of $4,600 per election if check is drawn from a joint account and both signatures are provided. Partnerships are also limited to $2,300 and must include the names of all partners with their percentage of ownership. Corporate contributions are prohibited by Federal Law. Cash contributions can not be accepted. Contributions from foreign nationals are prohibited.

Contributions to political committees are not deductible for Federal Income Tax purposes.

Federal Law requires Philbeck for Commissioner to use its best efforts to obtain and report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 in an election cycle.