District 21 Greens

the alternative choice for the 2003 New Jersey Legislative elections

Covering parts of Essex, Morris, Somerset & Union Counties in New Jersey

Fill out ALL information as required by law, and please print out this form before clicking the submit button.  Only United States Citizens and Permanent Residents may contribute to any U.S. election campaign.

For Contributions to "District 21 Greens", you must include the following information as required by New Jersey election campaign law.

<<  If you do not have an occupation or employer when answering the questions below, place "N/A" in the appropriate boxes/fields.  >>

Title
First Last
Address
Suite
City          State    Zip
Phone Work Phone
Email
*Employer *Occupation
*Retired
*Homemaker
*Employer Address
*Employer State
*Employer Zip
This is a onetime donation
This is a monthly donation

If the Amount of the Donation is $400.00 or above or you plan to give an aggregate during the campaign of $400.00 and above with the limit of $6,600 for this joint campaign, the above marked (*) information as required by New Jersey election campaign law will be reported.  For donations below $400.00, the campaign is required to keep this in our records.



Click "SUBMIT" to go to a SECURE DONOR page.  By clicking on the Submit button below, I certify that I have read and agreed to the above statement.
    
     

The maximum amount of any contribution for the "District 21 Greens" is $6,600.  Spouses may also give up to $6,600, providing their donation is made independently from funds over which they control.

Paid for by "District 21 Greens", P.O. Box 172, Gillette, NJ 07933  ●  (908) 322-4319  ●  Treasurer@District21Greens.org

Thank you for your donation, it is greatly appreciated!