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Henry for Arizona Contributions

Http://www.henryforaz.com

Please help Justin in his run for state legislature as we seek to make Arizona the best state in the nation.

Contribution Amount

$25
$50
$100
$250
$500
$750
$1,000
$1,500
$2,000 - Max Per Individual
$4,000 - Max Per Couple
$

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

Legal Compliance

I affirm that the following statements are true and accurate:

I understand contributions are not tax deductible. To comply with Arizona law, we must use best efforts to obtain, maintain, and submit the name, mailing address, occupation and name of employer of individuals whose contributions exceed $25 in an election cycle. The maximum contribution per individual per election cycle is $2,000 for the primary election and $2,000 for the general election.

I want to publish my name to the Henry for Arizona Contributions giving stream! (Note: your contribution amount will not be shown)

Your donation will appear on your credit card or bank statement as "RALLY/PIRYX"

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State law requires campaign committees to obtain the name, mailing address, occupation and employer for each individual contributor. Contributions are not tax deductible

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