 |
 |
 |
 |
 |
 |
PLEASE PRINT THIS FORM AND MAIL TO
Friends to Elect Dian Slavens
PO BOX 871212
Canton, MI 48187
I would like to help by contributing the following
The maximum donation allowed per person per election cycle is $500.
|
State law requires the following
information
|
|
|
Note:
Fields with an (*) are required.
|
|
|
* Name:
|
|
|
* Home Address:
|
|
|
* City:
|
|
|
* State:
|
|
| * ZIP: | |
| * Occupation: | |
| * Employer : | |
| * Business Address: | |
| * City: | |
| * State: | |
| * Zip: | |
Make checks payable to: Friends to Elect Dian Slavens
By law, corporate checks are not allowed, so we can only accept personal
checks. Please remember that contributions are not tax
deductible as charitable contributions for federal income tax purposes.
For further information, please e-mail me at: Dian@dianslavens.com.