Contribution Amount

• 
  $25
• 
  $50
• 
  $100
• 
  $250

• 
  $500
• 
  $1,000
• 
  $2,500
• 
  $5,000

• 
  $10,000
• 
  $

• Employer Address:Required
  
• Employer Address Line 2:
  
• CityRequired
  
• StateRequired
  AA AE AK AL AP AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY
• ZipRequired
  

Legal Compliance

I affirm that the following statements are true and accurate:

This contribution is made from my personal funds and is not drawn on an account maintained by a corporation, labor union, or national bank; and

I am a U.S. citizen or lawfully admitted permanent resident and this contribution will not be reimbursed by another person.

This is my personal credit card not funded by a corporation or other prohibited source.

This contribution will not be reimbursed by anyone else and will not cause my contribution to this candidate to exceed the $10,000 per individual or $20,000 per couple yearly contribution limit to all Wisconsin state political campaigns. Contributions are not tax deductible.1