Help Build A Better Future For America And Our Children ---
Support the RPUSA - ACTION GROUP
Become part of the growing team of dedicated Grassroots Reformers working with other Reformers nationwide to
Take Back America and implement the
'10 POINTS of REFORM for AMERICA'!
If you would like to contribute securely online click on the below link and it will take you to our dedicated web server.
If you would like to contribute by mail or fax:
Copy this form and paste it into your Email or Word program, print out and mail with your check or money order, made payable to:
RPUSA - AG, PO Box 488, Elkins, WV., 26241.
If you would like to donate by credit card by fax, simply fax the form to1-304-456-3282
Contribute by Mail or By Fax Form:
INFORMATION REQUIRED BY LAW:
Mr/Mrs/Ms.
First Name:
Middle Initial:
Last Name:
Address:
City:
State:
County:
Zip:
Phone:
Email:
Employer:
Occupation:
Credit Card Type: Visa - Master Card - American Express
Credit Card Number:_______________________
Exp Date:_______________
Amount: $ 25, 50, 100, 500, 1000, Other:
(NOTE 1: When donating by check, simply attach your check with this form, made payable and mailed to:
RPUSA - AG, P.O. Box 488, Elkins, WV 26241.
Simply copy and paste from the portion from name to occupation)
(NOTE 2: When donating by credit card, simply copy and paste this whole form. Kindly check to see that the address provided is the same as the billing address on the Credit Card.
All Credit Cards used MUST be personal and not corporate)
All funds received from individuals are subject to federal contribution limitations .
Contributions from corporations that have not formed a PAC, or from foreign nationals, are prohibitied by law.
For contributor assistance, please Email or Fax the
RPUSA -AG Finance Department at: Email: contactus@reformpartyusa-ag.org
Fax: 1.304.456.3282
Paid for by the RPUSA-AG www.reformpartyusa-ag.org
While contributions are used to assist various Reform candidates, the RPUSA-AG is not a finanical agent limited to any candidate or any specfic candidate's committee.
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Contributions from concerned citizens are critical to the successful efforts of the RPUSA-AG. Your donation helps increase public awareness and educates, trains, registers voters, recruits and elects Reform candidates! While ignorance is poverty and submission, Knowledge is Survival and Power! Power brings Change! Everyone can help Take Back America in more ways than one! Kindly visit the RPUSA-AG WishList!
YES! I want to join the efforts of the Reform Party USA - Action Group and Take Back America for Americans! I want to do my part to establish a successful grassroots organization to win future elections.
Here is my contribution for the front lines of the
Reform Party USA - Action Group!
I want to see a Reform Victory in the halls of Congress and in every State Capitol and in every County in America!
I believe in the Common Good before Self or any Special Interests!
NOTE: Political Contributions are not deductible as charitable contributions for federal income tax purposes.
(Kindly Read Notes below)
