Mail Contribution Form


State election law requires the Oklahomans for Anthony campaign to collect the name, address, occupation, employer and signature of individuals who contribute.



Contributor Name(s): ___________________________________________________________
 

Complete Address:
____________________________________________________________
 

______________________________________________________________________________
 

Occupation: ________________________

Employer: ___________________________



Contribution Amount: $_______________ 
(personal checks only)


Date of Contribution:
__________________

Declaration Required by State Law:
This contribution was freely and voluntarily given from my own funds, and I have not been directly or indirectly compensated or reimbursed for this contribution.
 

Contributor's Signature: X__________________________________________

All the information on this form is required by law. Please note that state law prohibits corporate checks and limits individual campaign contributions to $5,000 per household.

Please print this page. Then return the signed and completed form with your personal check made payable to:

Oklahomans for Anthony
P.O. Box 54598
Oklahoma City, OK 73154

Thank you!

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