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Support AmeriPAC

AmeriPAC welcomes your support. Your contributions are essential to execution of our missions.

Please print this form, complete the information, and return it with your donation to this address:

American Political Action Committee (AmeriPAC)
PO Box 1682
Bellevue, WA 98009-1682

Please make checks payable to AmeriPAC.

Name:	___________________________________
Address:	___________________________________
City, State, ZIP Code	___________________________________
Telephone	___________________________________
E-mail Address	___________________________________
The Federal Elections Commission (FEC) requires you to include employment information:
Occupation (or Retired)	___________________________________
Employer	___________________________________

Amount of Contribution	_____ $1000.00 _____ $500.00 _____ $200.00 _____ $100.00 _____ $50.00 _____ $25.00 _____ $15.00 _____ Other ($_________)

Thank you for your support of AmeriPAC’s important projects. Contributions made to AmeriPAC are not deductible for tax purposes. Registered with the Federal Election Commission since August 24, 1980, ID# #C99002396.