Contribution Form

Contribution Information

$20.00$40.00$60.00$100.00$250.00
$500.00$750.00$1000.00
$

Contact Information

First Name

Last Name

Phone/Mobile Number

Address 1

Address 2

City

Country

State

Zip

Payment Method

Credit/Debit Card eCheck Transfer

Card Type

Card Number

Expiration

Security Code

Bank Name

Account Type

Name on Account

Routing Number

Account Number

Legal Compliance

*ECMSProcessing.com will appear on your statement*

Type the code Shown

I affirm that the following statements are true and accurate:

Maximum contribution allowed under Florida’s campaign finance law is $1,000 per individual person, corporate entity, and/or Political Committee. Contributions are not deductible for federal income tax purposes.

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