PAC ENROLLMENT

one  CONTRIBUTOR INFORMATION

First / Last Name:
Occupation:
Employer:
Mailing Address:
City / State / Zip:
Email*:
*The confirmation email with be delivered to this address.

two  PLEDGE AMOUNT

I would like to make a personal credit card contribution to JPMA-PAC in the amount of $ .


three  PAYMENT INFORMATION

use contributor information
First / Last Name:
Billing Address:
City / State / Zip:
Card Type: credit cards accepted
Card Number:
Security Code:
Expiration Date:

four  DISCLAIMERS

Contributions to JPMA-PAC are not deductible for Federal income tax purposes. Contributions to JPMA-PAC are used to support federal candidates and committees, and are subject to the prohibitions and limitations of the Federal Election Campaign Act and applicable state laws. Participation is strictly voluntary and individuals may refuse to contribute without reprisal. Neither JPMA nor your employing company will favor or disadvantage any employee based on the amount of a contribution or a decision to not contribute. Individuals may contribute up to $5,000 in a calendar year. Political contributions cannot be reimbursed by an employees’ company or any other person.

Only U.S. citizens and lawfully admitted permanent residents (i.e. a Green Card holders residing in the U.S.) are eligible to contribute.

Federal law requires political action committees to use their best efforts to collect and report the name, mailing address, occupation, and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year. The FEC makes this information publicly available.


five  VERIFICATION STATEMENTS

Please verify the following statements are true and accurate by checking the boxes below.

This contribution is made from my own funds and not those of another.
This contribution is not made from the general treasury funds of a corporation, labor organization, or national bank.
This contribution is made on my personal credit or debit card for which I have the legal obligation to pay and is not made on a corporate credit card.
I am not a Federal government contractor, nor am I a foreign national who lacks permanent resident status in the United States.