Donate to Kim LaSata for State Senate

http://www.lasataforstatesenate.com

Please donate to Kim LaSata for State Senate. Help us raise money and share our cause today!

Contribution Amount

$50
$100
$250
$

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

Billing Information

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

Contribution Type

Make this monthly recurring contribution

for

I want to publish my name to the Donate to Kim LaSata for State Senate 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:

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

*Monthly contributions will end in November
*The maximum contribution allowable is $1,000 for an individual or $2,000 for a couple.
*Employer, Occupation, and Address are required by state law.

You can mail a check to PO Box 495, Saint Joseph MI 49085

Paid for by Kim LaSata for State Senate, PO BOX 495 Saint Joseph MI 49085

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.

Piryx™