Donation Form

Federal law requires political committees to report the name, mailing address, occupation and name of employer for each individual whose contributions exceed $100 in a calender year. Please fill in all information below.

First Name:
Last Name:
Employer: (required)
Occupation: (required)
Phone:
Amount: $ (limit $1000)
Please read and check each of the boxes below that apply. All boxes must be checked to comply with federal contribution requirements:
The funds I am donating are made from my own funds, and not from those of another.
This contribution is not made from the general treasury funds of a corporation, labor organization or national bank.
I am not a Federal government contractor, nor am I a foreign national who lacks permanent resident status in the United States.
I am at least 18 years old and this contribution is made on a personal credit or debit card for which I have the legal obligation to pay, and is made neither on a corporate or business entity card nor on the card of another.

Note: Please click Yes to accept certificate on next window, should certificate appear.
This contribution goes to:
The Libertarian Party of Colorado
6989 S. Jordan Road, Suite 5U
Centennial, Colorado 80112
Telephone: (303) 837-9393
and may not be earmarked for any particular candidate or issue. Your contribution may be used in connection with Federal elections and is subject to the regulations and limitations of the Federal Election Campaign Act. Your entire donation is a contribution to the Libertarian Party of Colorado. Donations are not U.S. tax deductible.