Contributions

       Thank you for your support of our campaign! We could not do it
       without you!

       If you would like to contribute by mail, download this form.

        Personal Information
First Name: *
Last Name: *
Address: * (Please use credit card billing address)
City: *
State: *
Zip: *
Phone: * (Please include Area Code)
Email: *
       Employment Information
Occupation: *
Employer: *
     Federal law requires political committees to use their best efforts to obtain and report the name,
     mailing address, occupation, and employer for each individual whose contributions aggregate in
     excess of $200 in an election cycle. Contributions to Jon Barela for Congress are not deductible
     as charitable donations for federal income tax purposes. Contributions from foreign nationals and
     corporations are prohibited.
       Contribution Amount
Amount: $ 
       Payment Information
For your protection: The address you provide should be the same as the billing address of your credit card.
Card Type
Credit Card #
Card Security Code
Expiration Date: /
     Disclaimer:
     Your contribution is not tax-deductible as a charitable contribution for income tax purposes.

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