Piryx™

Share This Page
Tweet 0

Donate to Ken Cuccinelli for Governor

http://www.cuccinelli.com

Help us raise $25,000 by this weekend.

Anyone who donates will be entered into a drawing for a chance to win two (2) tickets to sit in Ken's suite at the Convention and watch acceptance speech.

Donate now to help us reach this goal and keep our campaign moving forward!

Contribution Amount

$25
$50
$100
$250

$500
$1,000
$2,400
$

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

Legal Compliance

I affirm that the following statements are true and accurate:

This contribution is made from my own funds and not those of another.

I am not a foreign national who lacks permanent resident status in the United States.

I want to publish my name to the Donate to Ken Cuccinelli for Governor 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.

No contribution is required to enter to win. You can enter for a free chance to win by completing and submitting the entry form online, and we will contact you if you are the winner. To enter without making a contribution, please click here.

Paid for and authorized by Ken Cuccinelli for Governor

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.