Californians For Freedom - Advocating for Democracy in Syria

Californians For Freedom PAC

Contributor

First Name

Last Name

Street Address

City

State

Zip

Country

Phone

We are required to use our best efforts to collect and report your occupation and employer.

Please do not leave blank or enter 'N/A'.

EmployerIf self-employed, enter 'self'; if unemployed enter 'none' or 'retired'.

OccupationPlease complete even if self-employed; enter 'none' or 'retired' if unemployed.

I confirm that the following statements are true and accurate:

I understand that my payment is being made to Democracy Engine, who accepts the responsibility of distributing the funds to my designated recipient(s). My card or bank statement will show a payment to “Democracy Engine” and if there are any issues or discrepancies with the payment or I wish to revoke the payment, I can contact Democracy Engine at support@democracyengine.com.
I am at least eighteen years old.
I have read and accept the Democracy Engine Terms of Service, Privacy Policy, and Refund Policy.
Contributions to the Californians For Freedom PAC are not deductible as charitable donations for federal income tax purposes. Contributions from corporations, foreign nationals and minors are prohibited.
The maximum contribution per individual is $5,000 per year and up to $10,000 per year for couples.
Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 in a calendar year.
Contributions to the Californians For Freedom PAC need to be made with a personal credit card and not with a corporate or business credit card or a card issued to another person.

Make this a recurring donation …

That repeats

Until

donations have been made

Stopping after

Payment Method

Credit CardElectronic Check

Select a payment method to continue …

Card Number Four_cards

Expiration Date

Security Code (CVV)

Account Type

CheckingSavings

Routing (Bank) NumberOmit any dashes or spaces

Retype Routing Number

Account NumberOmit any dashes or spaces

Retype Account Number