| INSTRUCTIONS ON HOW TO MAIL OR EMAIL YOUR DONATIONS TO THE JACK SHEPARD FOR SENATE COMMITTEE ARE BELOW. THANK YOU |
| Candidate Jack Shepard thanks you for your kind donation and your support for his candidacy for The Senate USA, if elected he would use to create World Peace .Please send us this form with your donation which Federal law requires. |
| After your donation on line for legal compliance it's necessary that you complete the form below and send it us or we cannot accept your donation. Please complete the feedback box with your name, the amount of the donation and yes. |
| If you donate on line please click on: |
| After your donation on line for legal compliance it's necessary that you complete the form above and send it us or we cannot accept your donation. Please complete the feedback box with your name, the amount of the donation and yes. |
By sending and signing this form I affirm that:
1. I am a United States citizen or a lawfully-admitted permanent resident.
2. I am at least 16 years old.
3. This contribution is not made from the general treasury funds corporation, of labor organization or national bank.
4. This contribution is not made from the funds of a political action committee.
5. This contribution is not made from the treasury of an entity or person who is a federal contractor.
6. This contribution is not made from the funds of an individual registered as a federal lobbyist or a
foreign agent, or an entity that is a federally registered lobbying firm or foreign agent.
7. The funds I am donating are not being provided to me by another person or entity for the purpose of
making this contribution
8. Federal law requires us to use our best efforts to collect and report the name, mailing address,
occupation and employer of individuals whose contributions exceed $200 in an election cycle.;
Sign_____________________________________________ date_____________
1. I am a United States citizen or a lawfully-admitted permanent resident.
2. I am at least 16 years old.
3. This contribution is not made from the general treasury funds corporation, of labor organization or national bank.
4. This contribution is not made from the funds of a political action committee.
5. This contribution is not made from the treasury of an entity or person who is a federal contractor.
6. This contribution is not made from the funds of an individual registered as a federal lobbyist or a
foreign agent, or an entity that is a federally registered lobbying firm or foreign agent.
7. The funds I am donating are not being provided to me by another person or entity for the purpose of
making this contribution
8. Federal law requires us to use our best efforts to collect and report the name, mailing address,
occupation and employer of individuals whose contributions exceed $200 in an election cycle.;
Sign_____________________________________________ date_____________
| Your contribution is not tax-deductible for federal income tax Purposes. . An individual may contribute a maximum of $2,300 per election (Primary and General are separate elections) By submitting your contribution, you agree that the first $2,300 is designated for the Primary and any additional amount up to $2,300 is designated for the general election made payable to Jack Shepard for Senate Committee Non-transferable account #7009616 |
Your contribution is not tax-deductible for federal income tax Purposes. . An individual may
contribute a maximum of $2,300 per election (Primary and General are separate elections) By
submitting your contribution, you agree that the first $2,300 is designated for the Primary and
any additional amount up to $2,300 is designated for the general electionmade payable to Jack
Shepard for Senate CommitteeJack Shepard for Senate CommitteePlease make all checks
Non-transferable
Please bill my personal credit card: __Visa __MasterCard __AMEX__DiscoverAmount:
$_____________(Maximum contribution is $4,600 per person)*Card
Number:___________________________ Exp:_________________Name as it appears on the
card:__________________________________
Signature:_____________________________________________ For the Jack Shepard for
Senate Committee
By signing above, you authorize the Jack Shepard for Senate Committee to charge your
card for a donation in the Amount indicated, and also please remember to complete the
donation qualification form above and include it; thank you.
contribute a maximum of $2,300 per election (Primary and General are separate elections) By
submitting your contribution, you agree that the first $2,300 is designated for the Primary and
any additional amount up to $2,300 is designated for the general electionmade payable to Jack
Shepard for Senate CommitteeJack Shepard for Senate CommitteePlease make all checks
Non-transferable
Please bill my personal credit card: __Visa __MasterCard __AMEX__DiscoverAmount:
$_____________(Maximum contribution is $4,600 per person)*Card
Number:___________________________ Exp:_________________Name as it appears on the
card:__________________________________
Signature:_____________________________________________ For the Jack Shepard for
Senate Committee
By signing above, you authorize the Jack Shepard for Senate Committee to charge your
card for a donation in the Amount indicated, and also please remember to complete the
donation qualification form above and include it; thank you.
| Your contribution is not tax-deductible for federal income tax Purposes. . An individual may contribute a maximum of $2,300 per election (Primary and General are separate elections) By submitting your contribution, you agree that the first $2,300 is designated for the Primary and any additional amount up to $2,300 is designated for the general election made payable to Jack Shepard for Senate Committee Jack Shepard for Senate Committee |
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