Personal Information
First Name *  
Last Name *  
Address *  
Address con't   
City *  
State *
Zip *  
Email *  
Phone *  
We are required by law to ask for the following information.
  Check this box if you are retired, otherwise please complete the following fields.
Occupation *  
Employer *  
Employer Address *  
Employer Address Con't   
Employer City *  
Employer State *
Zip *  
Payment Information. For your protection: The address you provide above should be the same as the billing address of your credit card.
Card Type *        
Credit Card # *  
Expiration Date *
Card Security Code *  
Make a one-time, Non-refundable donation to Paul Farrow
$5.00      $10.00      $25.00      $50.00      $100.00     
$250.00      $500.00      $1,000.00      $2,000.00      $3,000.00     

Other: $
State and Federal Law requires that you verify the following statements are true and accurate by checking the box below.

By checking this box, I certify this is my personal credit card not funded by a corporation or other prohibited source. This contribution will not be reimbursed by anyone else and will not cause my contribution to this candidate to exceed the contribution limit to a Waukesha County Executive campaign.

Paid for by Friends For Paul Farrow, Paul Melnick, Treasurer
P O Box 467
Pewaukee, WI 53072

To see how your donation will appear on your credit card statement, click here!

Powered by