Piryx™

Share This Page
Tweet 0

Jonathan M. Tallman for Florida House Representatives District 4

http://www.facebook.com/votetallman

If you would prefer to contribute via check, contributions can be mailed to

Jonathan Tallman for Florida House

1456 Oakmont Place

Niceville, FL 32578

Contribution Amount

$25
$50
$100
$250

$500
$1,000
$

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:

Contributions not deductible for Federal income tax purposes.

The maximum contribution allowed under Florida law is $1,000 per individual or entity.

I want to publish my name to the Jonathan M. Tallman for Florida House Representatives District 4 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 advertisement paid for and approved by Jonathan M. Tallman, Republican, for State Represenative District 4.

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.