Donation

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Contact Information

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Organization Name: Prefix: First Name: Middle Name: Last Name: Suffix: Phone: Email:

Address

California law requires political parties to collect the name, street address (no P.O. Box), occupation, and employer for every individual who remits payment including, donations, membership, or event fees.

Street Address: City: State: Province (Foreign) Zip Code: - Country:

State Mandated Information

If you are self-employed list the name of the business in "Employer."
Use Retired/Retired—Student/[School Name]—Unemployed/Unemployed, as applicable.

Occupation Employer

Donation Amount and Note:

Suggested Donation Amounts:

$ 10

$ 15

$ 25

$ 50

$ 100

$ 200

$ 500

$1,000

Other Amount: $10 minimum

$ 10

$ 15

$ 25

$ 50

$ 100

$ 200

$ 500

$1,000

Other Amount: $10 minimum

This is a one time donation

Make this a recurring donation deducted

Portion to County: Note:

Billing Information

Payment method: Credit Card
American Express

E-Check PayPal

Use a Credit/Debit Card

Credit Card Number: Card Expiration: Credit Card CVV2:

Cardholder First Name: Cardholder Last Name: Billing Address: City: State: Zip Code: -

"By clicking the 'Submit' button, I authorize the Libertarian Party of California to charge my Credit Card/Bank Account. If I have indicated that it should be a recurring donation, the charge will be made today, and each following period, until I send notice to revoke the authorization, by calling (916) 446-1776 , emailing office@ca.lp.org, or writing The Libertarian Party of California, 428 J Street, Ste 400, Sacramento, CA, 95814-3361. I understand that it may take up to 15 business days for the revocation to become effective depending on my chosen method."

NOTE: Please only click the 'SUBMIT' button once. Your payment may take time to process.

E-Check Billing Information Institution: Routing Number: Account Number: Account Type: Account Owner Full Name: Account Holder Email:

NOTE: Please only click the 'SUBMIT' button once. Your payment may take time to process.

Click this button to make your payment via PayPal.
Note: You will be redirected here once your payment is processed by PayPal.