______________________Please Fill out Email form______________________

This form reports information to the candidate, which will help with campaign accounting and compliance reporting. Please fill it out as completely as possible.

When you are done, please click the "Report Your Contribution" button. This will open an email to the candidate containing the details of your contribution. Finally, click the "Process Contribution" Link. This will take you to another page where you will receive instructions on how to process a check or credit card contribution. The process is simple and should take just a few minutes of your time.

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Secure Transaction 

Personal Information   (credit card billing information)
Prefix *  Last Name  *  First Name  *
Middle Name *  Suffix *
Birth Date (Day, Month, Year)   *
Preferred Name Address  * City  *
Michigan County  *
 State / Province * 
Zip Code *
Home Phone * Work Phone * Ext *
Fax Number  *
Email *
Email (confirm)*

Information Required by Federal  Law

Occupation *
Employer     *
Employer Address *

 If you are retired, please enter N/A under Employer and Retired under Occupation; if a homemaker, please enter N/A - Homemaker; if self-employed, please enter Self-Employed under Employer and describe your line of work under Occupation.

Contribution Information:
Contribution Requirements

  1. Contributions of any amount must have the donor’s name and address, and must be paid by check if greater than $20.01. Cash contributions of $20 or less are acceptable.
  2. Contributions of $100.01 or more, either at one time or accumulated during the election cycle, from a single individual, must also provide information on the donor’s occupation, employer and principal place of business.
  3. Contribution limits are $1000 per individual, and $10,000 per PAC. Contributions from a dependent minor are counted against contributions given by the parent or guardian.
  4. No contributions from Foreign Nationals, Labor Organizations, Native American Tribes, Persons holding a Casino Interest in the three Detroit Casinos.

Amount (do not include dollar sign) $*
* Amount must be a number between 5.00 and 2,100.00. This number cannot have more than 2 decimal places.
 $25   $50   $100  $200
$500 $1000$2100Other

Enter Your Payment Information Here  
Payment type: *
Debit/Credit:
Your Name exactly as it appears on Card *
Type of Credit Card Mark with *
Card Expires *
Year: *

I confirm that the following statements are true and accurate:
- I am not a foreign national who lacks permanent residence in the United States.
- This contribution is made from my own funds, and not those of another.
- This contribution is not made from the funds of a corporation or labor organization.
- This contribution is made on a personal credit card or debit card for which I have the legal obligation to pay, and is not made either on a corporate or business entity card or on the card of another person.
- I am at least eighteen years old.

Contributions or gifts to Ted Norris Dundee Village President are not tax deductible.

Full Name *

Please add me to your electronic mailing list. *

* Indicates a required field

 
______________________End of  Email form______________________
Click the link below to "Finnish your Contribution"