Piryx™

Share This Page
Tweet 0

Donate to The Committee to Elect Jim Bussler

http://www.jimbusslerforcongress.com

Federal law requires us to report the name and mailing address of each contributor. This information is used for reporting purposes only. You will receive a receipt of your contribution by e-mail.

Contribution Amount

$10
$25
$50
$100
$250
$500
$1,000
$2,500
$5,200 - Maximum Per Person
$

Personal Information

First NameRequired
Last NameRequired
EmailRequired
Home AddressRequired
Home Address (line 2)
CityRequired
StateRequired
Zip/PostalRequired
Phone NumberRequired

Employment Information

EmployerRequired
OccupationRequired

Payment Information

Debit/Credit Card

Card Number
CSC ?
Expiration

Routing Number
Account Number

Billing Information

Same as home address.
Billing Address
Billing Address (line 2)
City
State
Zip/Postal

Contribution Type

Make this monthly recurring contribution

for

Legal Compliance

I affirm that the following statements are true and accurate:

I am at least 18 years old.
I am a U.S. citizen or have permanent residence status.
I am not a federal government contractor.
The funds of the contribution are from my own personal funds and are not being provided to me by another person or entity.
The funds of the contribution are from my own personal funds and are not from the treasury of a corporation or labor union.

I want to publish my name to the Donate to The Committee to Elect Jim Bussler giving stream! (Note: your contribution amount will not be shown)

Your donation will appear on your credit card or bank statement as "RALLY/PIRYX"

Amount:

Your donation is being submitted. Please be patient.

By clicking submit you agree to our refund policy in our terms of service.

Contributions are not tax-deductible for federal income tax purposes.

If you would like to send a check, please send it to:

The Committee to Elect jim Bussler

205 W. High St.
Dowagiac, MI 49047

This form is secured using 256-bit SSL encryption.

Piryx - The Social Giving Platform

Now fundraising is as easy as writing a blog or posting a status update and can be integrated into your website, product or mobile app. With Piryx, causes raise money online in more volume and much more effectively across the web. To learn more and create your own free account visit Piryx.com.