printable contribution form

Printable Contribution Form

CONTRIBUTION FORM

Thank you for your interest in contributing. Your contribution are used in many ways to help the Wallingford Republican Town Committee in our election. Contributions help to make our Election Day efforts a huge success.

Donations to the Wallingford Republican Town Committee are governed by state law, which does not currently allow for credit card contributions. We have provided this form to simplify the donation process and to comply with state law.

Contribution Directions: 1. Please fill out all applicable fields below.

Name:
Address 1:
Address 2:
City:
State:
Zip / Postal Code:
Country:
Phone Number:
Email Address:
Comments/Questions:

Lobbyist:	Yes No
Are you the dependent of a lobbyist?	Yes No
Do you have a contract with the State of CT valued at more than $5,000?	Yes No
Are you a director, officer, limited or general partner or holder of 5% stock in a business which has a contract with the State of Connecticut valued at more than $5,000?	Yes No

Please make checks payable to Wallingford Republican Town Committee

Once you have filled this form in please use your browser to print it out.
You can then mail this form along with your contribution to:

Wallingford Repulican Town Committee

c/o June Seichter, Treasurer

163 Grieb Road

Wallingford, CT 064923