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*Please NOTE that if you choose to contribute more than $200, you must supply your occupation and employer:
*Occupation
*Employer



Please affirm the following:
I agree to pay all charges incurred in using this credit card to make a contribution and the true source of this contribution is my own personal funds.
I acknowledge that I am a U.S. citizen at least 18 years of age and legally able to contribute to a political campaign.