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Informed Voters/Federal Donor

YES, I want to make a contribution!

$50    $100    $200    Other ______

Please make checks payable to: Informed Voters of Michigan Federal Committee (Corporate Checks Not Accepted)

Donor Information

Name_________________________________________________________________
Address_______________________________________________________________
City/State/Zip___________________________________________________________
Phone (     )_________________________Email_______________________________

Employment Information
Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and employer for individuals whose contributions exceed $200 in a calendar year.  To help Informed Voters comply with this law, please provide the following information:

Employer's Name____________________________________________
Occupation_________________________________________________

Informed Voters can accept individual contributions of up to $5,000 per calendar year to our federal account.
Eligibility
In order to comply with Federal Election Commission requirements, we must confirm that the following statements are true and accurate.  Please check the box of each statement that applies to you.  Your contribution cannot be accepted unless each box is checked.
This contribution is made from my own funds and not from those of another.
This contribution is not made from the general treasury funds of a corporation, labor organization or national bank.
I am not a federal government contractor, nor am I am foreign national who lacks permanent resident status in the United States.
Contributions to Informed Voters are not deductible for federal income tax purposes.


Thank you for your support!


Contributions may be mailed with this form to:
Informed Voters of Michigan, PAC
P.O. Box 43499
Detroit, Michigan 48243