Bret2005: Contribution Center

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If you prefer to contribute over the phone, please contact Monica Navarro at (908) 379-2738. If you would prefer to contribute via mail, please download, complete, and mail back this PDF form to campaign headquarters. Please email Monica Navarro at monica@bret2005.com if you need any assistance.

We are required by state law to collect all information marked as a required field (*) to accept your contribution.

*First Name:

*Last Name:

*Address:

*City:

*State:

*Zip:

*Phone:

*Email:

THE FOLLOWING INFORMATION IS ALSO REQUIRED:
If you are retired, a homemaker, or unemployed, please enter "N/A" in the Employer fields.

Please select one if it pertains to you
Retired
Homemaker
Unemployed

*Employer:

*Occupation:

*Employer's Address

*Contribution Amount:

$ 5	$10	$25
$ 50	$75	$100
$ 250	$500	$1000
$2000	$3000	$other

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About the program $20/per pack

*Card Number:
(no dashes or spaces, please)

*Expiration Date:

*Card Type:

* I acknowledge the following statements to be true. (MUST BE CHECKED)

I am not a foreign national who lacks permanent residence in the United States.
This contribution is made from my own funds, and not those of another person.
This contribution is made on a personal credit card or debit card for which I have the legal obligation to pay, and is not made on a card of another person.
I am at least 18 years old.

All contributions must meet the following regulations:

Contributions for the primary election are limited to $3000 per person, corporation, P.C., P.A. or PAC.
If the contributor is an individual, the contributor must provide his or her occupation, employer and employer’s address.
A partnership may contribute a maximum of $3000 per partner for the primary election. A partnership check must include each contributing partner’s signature and address. A partner’s total contribution through the partnership and personally, cannot exceed the $3000 limit for the primary election.
Contributions of more than $3000 from affiliated corporations are prohibited. (Two or more corporations are considered affiliated if any individual, corporation, partnership, company, association, or other entity owns directly or indirectly more than a 30% interest in the other such corporation.)
Contributions from industries regulated by the State of New Jersey and their affiliates are prohibited. (Regulated industries include banks, insurance companies, casinos, utilities, etc.)
Contributions are not tax deductible.

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