Yes! We will be attending the kickoff on 05/25/21. Nick can count on me/us participating at the following level:
$1,000 $500 $250 $100 Other _______
No, we are unable to attend the kickoff, however we are enclosing our support in the amount of &__________ This contribution is from:
Business (Name of business): __________________________________________________ Individual
Please make check(s) payable to:
“Nick DiCeglie Campaign” 2840 W. Bay Drive #211 Belleair Bluffs, 33770 Contact: Rick Porter 407-849-1112 Secure Fax Line: 321-697-7092 rick@politicalcapitalflorida.com http://nickdiceglie.com/kickoff
The maximum personal or corporate contribution is $1,000 per election. Contributions are not deductible for federal income tax purposes. The individual making the contribution must sign the check. A husband and wife must each sign separate checks. Foreign nationals are prohibited from contributing unless they have a green card. Donor information accompanying checks must include donor’s full name, street mailing address, occupation (if corporation, type of business), phone number(s) and email address.
CONTRIBUTOR INFORMATION
Contact Name: Prefix: _______ First: ____________________ Middle: _________ Last: _____________________________ Address:___________________________________________________________ Home Phone: ___________________________ City:_________________________________
State:________
Zip:___________ Work Phone: __________________________ Type of Business (for corporations): _________________________
Amount: ___________ Cell Phone: ____________ Occupation:________________________________________ Email:________________________________________________ Assistant’s Name and Contact Information: __________________________________________________________________
CREDIT CARD CONTRIBUTIONS
Credit Card:
(circle one
)
VISA
MasterCard
American Express
Discover
This card is used for:
!
Business
!
Personal If business, name of business: _____________________________ Card Number:_____________________________________________________________________________________________ Amount: $_____________________ Expiration Date: ________________________________ CSC: ___________________ Cardholder Name:__________________________________ Signature:______________________________ Date: ________
Event Code: 0521KICKOFF
Contributions are not deductible for federal income tax purposes. The Maximum contribution allowed by Florida Law is $1,000 per individual or business. Paid by Nick DiCeglie, Republican, for State Senate.