Yes! Rudy can count on me/us participating at the following level:
$9,200 (Maximum Contribution for General and Primary Election Funds per couple)
$4,600 (Maximum Contribution for General and Primary Election Funds per individual)
I have already contributed the maximum amount to the primary election and want to contribute an additional
$____________ (up to $2,300) for the general election.
$2,300 (Maximum Contribution Primary Election Funds per individual)

Please make check(s) payable to:



OTHER ________

“Rudy Giuliani Presidential Committee, Inc.”
P.O. Box 1023
Merrifield, VA 22116-9565

Federal law requires us to obtain and report the name, mailing address, occupation and name of employer for each
individual whose contributions aggregate in excess of $200 in an election cycle.
Name: Prefix: _____ First: _________________________ Middle: __________ Last: ________________________
Address: ______________________________________ City: __________________ State: _____ Zip: __________
Home #: ___________________________ Cell #: ___________________________ Work #: _________________
Fax #: _____________________________ Email: ____________________________________________________
Employer: _________________________________________ Occupation: ________________________________
My signature below attests that this contribution is made by check or credit card from my personal funds and is not drawn on an account maintained
by an incorporated entity. I am a US Citizen or permanent resident and this contribution will not be reimbursed by another person. In order for a
contribution from a joint account to be attributed equally to two individuals, both individuals must sign this form.

Signature: _________________________________________

Spouse Contributor Information for Joint Contributions
Name: Prefix: _____ First: _________________________ Middle: __________ Last: ________________________
Nickname: _________________________________________ Home #: __________________________________
Work #: ________________________________ Email: _______________________________________________
Employer: ________________________________________ Occupation: _________________________________
If this contribution is intended to be a contribution from a couple, signature of spouse must be provided.
Signature: _______________________________________________

Credit Card Contributions: (please check one)
American Express
Card Number: __________________________________________ Expiration Date: _________________________
Amount: $_________________________ Cardholder Name: ___________________________________________
Signature: _________________________________________
Contributions are not deductible for federal income tax purposes. Federal Election Law requires us to report the name, address, occupation, and employer for contributions that
aggregate in excess of $200 in an election cycle. The maximum an individual may contribute is $2,300 per election, with the primary and general elections treated separately. As a
result, any initial contribution up to $2,300 is designated for the primary and any additional amount is designated for the general, up to a total of $4,600 per person. A couple may
contribute $9,200, designated per person in accordance with the proceeding sentence. Federal multi-candidate PACs may contribute $5,000 for the primary and $5,000 for the
general. Contributions from corporations, labor organizations, federal government contractors, and foreign nationals without permanent residency status ("green cards") are


Tracking #:
Paid for by the Rudy Giuliani Presidential Committee, Inc.

Event Code: