Vondersaar for US House Contribution Form

 

Please fill out form and return with contribution to:

 

                                      Vondersaar for US House

                                      1740 Saltwater Dr.

                                      Homer, AK 99603

 

Name:        ___________________________________________

                                                First                        Mid. Init                                                Last

 

Address:    ___________________________________________

 

City/State/Zip code: ___________________________________

 

Email address: _______________________________________

 

Donor Employer: _____________________________________

 

Donor Occupation: ____________________________________

 

Under penalty of perjury, I confirm that the following statements are true and accurate: I am a United States citizen or permanent resident alien. This contribution is not made from the general treasury funds of a corporation, labor organization or national bank. This contribution is not made from the treasury of an entity or person who is a federal contractor. The funds I am donating are not being provided to me by another person or entity for the purpose of making this contribution.

 

 

Signature ________________________________________