Contribution Form

Federal Election Committee

Contributor

Full name *

Email *

Mailing address *

Employer *

Occupation *

Contribution

$25

$50

$100

$250

Other amount$

Required attestations

I certify, by marking each box, that:

I am a United States citizen or a lawfully admitted permanent resident.

This contribution is made from my own funds and is not reimbursed by any other person or entity.

I am not a federal contractor, and this contribution is not made from corporate or labor-organization funds.

Payment

Card — last four only; the full number is captured securely

•••• •••• •••• Processed securely. Full card number and CVV are never written on this form.

Check enclosed, payable to Vega for Senate

Contributor signature

Date

Federal law requires us to use best efforts to collect and report the name, mailing address, occupation, and employer of contributors whose aggregate contributions exceed $200 in an election cycle. Contributions are limited to $3,300 per individual per election and are not tax-deductible. Contributions from corporations, labor organizations, federal contractors, and foreign nationals are prohibited. Paid for by Vega for Senate; not authorized by any candidate or candidate's committee other than Marisol Vega for Senate.