Brian Ignatowski for State Rep

Payment Information

We accept:

SELECT AMOUNT:*

OTHER AMOUNT:

DONATION TYPE:

CREDIT CARD #:*

EXPIRES ON:*

CVV:*

What's this?

NAME ON CARD:*

EMAIL:*

PHONE #:*

Personal Information

FIRST NAME:*

LAST NAME:*

ADDRESS:*

ADDRESS 2:

CITY:*

STATE:*

ZIP:*

OCCUPATION:

EMPLOYER:

Billing Address

Same as Personal Address

ADDRESS:*

ADDRESS 2:

CITY:*

STATE:*

ZIP:*

Confirm and Submit

• I affirm that I am making this contribution via my personal credit or debit card for which I have a legal obligation to pay, and not through a corporate or business entity card or the card of another person.
• My contribution is made from personal funds, and not from the general treasury funds of a corporation, organization or national bank.
• I have not received any funds from another person or entity for the purposes of making this contribution.
• I am a United States citizen, or a Green Card Holder who has been lawfully admitted for permanent residence and this contribution will not be reimbursed by another person.

I agree to the terms above

(If you need help with your submission, please contact support@transaxt.com)

Paid for by Brian Ignatowski for State Representative P.O. Box 747 Lakeland MI 48143

Service provided by Transaxt.com


	CVV - Credit Card Verification Code If you look on the back of your credit card, you should see your card number printed with an additional 3-4 numbers at the end. Please enter these additional numbers into the "CVV" field.