You are on page 1of 1

Obama for America

***Please in clude this page with you r contributio n***


Yes, I would like to contribute $2,300 in primary funds and attend the luncheon.
I would like more information about joining the Host Committee. Please contact me.
I’m not able to attend but would like to contribute $______ to Senator Obama.
Please make checks payable to:
Obama for America
418 Florence Street
Palo Alto, CA 94301
or
Fax your credit card information to: (650) 325-9041
Please bill my personal credit card: Visa MasterCard AMEX Discover
Amount: $_______________
Maximum contribution $4,600 per person*

Card Number: _______________________________________Exp: ___________________


Name as it appears on the card: _________________________________________________
Signature: __________________________________________________________________
By signing above, you authorize us to charge your card in the amount indicated. You also affirm that your contribution is
made from personal funds and not from funds otherwise prohibited by law.
Obama for America does not accept contributions from currently registered federal lobbyists, registered foreign agents,
political action committees, or minors under the age of 16.
Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and employer of individuals
whose contributions exceed $200 in an election cycle.

First & Last Name: __________________________________________________________


Address: __________________________________________________________________
City/State/Zip: _____________________________________________________________
Employer: ___________________________ Occupation:____________________________
Work Phone:____________________________Work Fax: ___________________________
Home Phone:___________________________ Email: ______________________________
*An individual may contribute a maximum of $2,300 per election (the primary and general are separate elections). By submitting your contribution,
you agree that the first $2,300 is designated for the primary, and any additional amount up to $2,300 is designated for the general election.

Contributions or gifts to Obama for America are not tax deductible. Federal law prohibits the acceptance of corporate contributions.
Paid for by Obama for America.
FI-491 RAISER_________________________