Piryx™

Share This Page
Tweet 7

Donate to William Field

http://www.facebook.com/fieldforsenate

$4,050.00

Raised: $4,050.00 Goal: $5,000.00

The 30th Legislative District needs better representation! Dr. William Field is running for Senate to make the right decisions for the people.

Please visit fieldforsenate.com.

Join our team! Help us by making a donation today by filling out the form below and share our message today!

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 Donate to William Field 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.

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.