Donate to Friends of Dick Lugar

Contribution Amount

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

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:

This contribution is made from my personal funds and is not drawn on an account maintained by a corporation, labor union, or national bank; and I am a U.S. citizen or lawfully admitted permanent resident and this contribution will not be reimbursed by another person. I am not a federal contractor. I am making this contribution on my own personal credit card and not with a corporate or business credit card or a credit card issued to anyone else. I am at least 18 years of age. By submitting this form I affirm that the above statements are true and accurate.

I want to publish my name to the Donate to Friends of Dick Lugar 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:

By clicking submit you agree to our refund policy in our terms of service.

Donations are not deductible as charitable donations for federal income tax purposes. Federal law requires us to report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 in an election cycle. Contributions from corporations, federal government contractors (PAC contributions are allowed up to $5,000 for the Primary Election and $5,000 for the General Election) and foreign nationals are prohibited. Individuals may contribute $2,500 for the Primary Election and $2,500 for the General Election.

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.

Piryx™