Donor Information Site

The Government Requires that a record be kept of the
Name, Address, Occupation and Amount of the Donation
for each person who donates to a Political Action Committee (PAC).

The following form has been set up for you to enter that information
for our records
BEFORE you make your donation to

Remember that the Amount you put in this form as being donated
must match the Amount that you put into the PayPal form.

Thank you so much for your Donation.

Items with an " * " next to them are REQUIRED.

* Name:
* Address:
* City:
* State:
* Zip Code:
* Occupation:
* Amount Being Donated at this Time:
Phone Number:
(For MoFed use Only)
Email Address:
(For MoFed use Only)

Donations made to MOFED PAC are not deductible for tax purposes.

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