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First Name *

Middle Name

Last Name *

Home Address *

City *

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Phone *

Email *

Occupation *

Employer *

Work Address *

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Amount *

Contribution Rules:

I am at least eighteen years old.
This contribution is made from my own funds, and funds are not being provided to me by another person or entity for the purpose of making this contribution.
I am making this contribution with my own personal credit card and not with a corporate or business credit card or a card issued to another person.
I am a U.S. citizen or lawfully admitted permanent resident (i.e., green card holder).

Maximum contribution $1,000.00.
Contributions are not tax deductible for federal income tax purposes.
State law requires us to provide names and mailing address, occupation, employer and employer address for contributions over $100.00.
Corporate Checks or credit cards are not allowed.

Paid for by Committee to Elect Jaafar- PO Box 527, Northville, MI 48167

Committee To Elect Angela Jaafar

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