Piryx™

Share This Page
Tweet 0

Support Lee Burton's Campaign for State Representative | District 156

http://www.leeburton156.com

Contribute. Help make Lee Burton your next State Representative (GA-156).

Make checks payable to:

Friends of Lee Burton

705 Green Street

Vidalia, GA 30474

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

Contribution Type

Make this monthly recurring contribution

for

I want to publish my name to the Support Lee Burton's Campaign for State Representative | District 156 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 to Friends of Lee Burton are not deductible for tax purposes. State law allows individuals, corporations, and Political Action Committees to contribute a maximum of $6,300 for the primary, $3,700 for the runoff, and $6,300 for the general election. State law requires political committees to report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $100 in a calendar year.

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.