To send a check, please complete and print this form,
and mail it with your order to this address:

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

Please make checks payable to AmeriPAC.

By clicking on the “Donate” button you confirm that the following statements are true and accurate:

• 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.
• This contribution is not made from the funds of a corporation or labor organization.
• 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 either on a corporate or business entity card or on the card of another person.
• I am at least eighteen years old.

Donations are not tax deductible.