Piryx™

Share This Page
Tweet 1

Contribute to the Dr. Mark Shelton Campaign

I appreciate your donation to my campaign. Your support helps me communicate with voters about important campaign activities, elections, and public policy. Please fill out the form below. After submitting this form, your donation will be processed securely and you will receive a confirmation email. Thank you very much for your continued support!

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:

Please affirm your compliance with the following regulations:

Corporate contributions are prohibited.
Contributions are not tax deductible.
State law requires employer and occupation for contributions of $500 or more.

If you have additional questions, please feel free to contact us at info@votemarkshelton.com. Thank you for your contribution.

I want to publish my name to the Contribute to the Dr. Mark Shelton Campaign 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.

Political Ad Paid for By the Mark Shelton Campaign

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.