Mail-In Form

Contributions to the Maza for Senate Campaign

NOTE: Please make check payable to: Maza for Senate Committee

IMPORTANT: Only checks from individuals can be accepted. Please do not send corporate checks (regardless of the size of the business).

Please include your name and contact information with all contributions:

Name:

___________________________________________________________________
                 (First Name)                  (Middle Initial)                  (Last Name)

Mailing Address:

___________________________________________________________________
                 (Street Address Line #1)

___________________________________________________________________
                 (Street Address Line #2)

___________________________________________________________________
                 (City)                                 (State)                           (Zip Code)

Campaign Finance Reporting Notice: If your contribution is above $250.00, you must include the following information:

___________________________________________________________________
                 (Your employer/principal place of business and your employer’s mailing address)

___________________________________________________________________
                 (Your occupation/job title)

Mail your contribution to:

For Your Records

Contribution to: Maza for Senate Committee

Date of check: _______________________

Amount of donation: __________________

Check number: ______________________