Please fill out all of the information below and mail it, along with your donation, to:

Schaeffer for State House
1618 Scenic Loop
Fairbanks, AK 99709

You can also fax this form to: (907)374-8979

 

Name: _________________________________________________________________

 

 

Billing Address: _____________________________________________________ State___________ ZIP________________

 

 

If you are donating more than $250, APOC regulations require your occupation and employer information. You do not need to fill out the information below if you are donating less than $250.

 

Occupation:_____________________________________________ Employer:___________________________________

 

__________________________________________________________________________________________________________________________________________________

Form of Donation: ____ Cash (Limit is $100)       Amount of Donation:_______________________

                              ____ Check (Make checks or money orders payable to Schaeffer for State House)

                              ____ Money Order

                              ____ Credit Card     Type:   VISA      MASTERCARD     OTHER (specify)____________________________

                              CC#___________________________________ VIN#_____________


                              NAME ON CARD ______________________________________EXP. DATE____________

 

SIGNATURE_________________________________________________ EMAIL:____________________________________



If you need a receipt please check here _________


Thank you for supporting Schaeffer in his run for State House!