If an organization contribution, please check box and provide the following information. If making donation as an individual, please enter N/A in all fields.
Please provide the organization name:
Contributor is a business (including LLCs) or nonprofit whose contributions to the campaign total $10,000 or more.
Name and title of CEO, CFO, COO, ED, Board Chair, President, or VP:
Has the contributing entity received funds via a SF City contract/grant in the last 24 months for a project in the City’s jurisdiction?
If “True” please answer below. If "False", enter N/A. City agency providing funding:
Value of contract/grant:
Contributor is a Limited Liability Company (LLC), also provide the following (or enter N/A).
Approver of Contribution:
Did a City elected official solicit your contribution?
If 'true', provide official’s name (if 'false', enter N/A):
Please select event
Cheng/Fong/Jung - May 12
Winnicker, Kawa, Henkle, Hirsch, Leal, Randolph - May 18th
Marshall-Green/Perez - May 27th
DeCaigny - June 17th
Remski/Belden/Corgas/Lloyd/Smith/Agid - June 17th
Teeth - June 17th
Hernandez - June 22nd
Imperial Palace - June 24th
if other, please provide
Campaign finance law requires us to obtain your occupation and employer.
If self-employed, enter the name of your business; if unemployed enter 'none' or 'retired'.
Please complete even if self-employed; enter 'none' or 'retired' if unemployed.