Yes, I would like to support Dave Winters. Please find
enclosed my check in the amount of (please specify):
___$25 ___$50 ___$100 ___$250 ___$500
___$1,000 ___Other $______________
ILLINOIS LAW REQUIRES POLITICAL COMMITTEES TO USE THEIR BEST EFFORTS TO RECORD
THE NAME, MAILING ADDRESS, NAME OF EMPLOYER AND OCCUPATION FOR EACH INDIVIDUAL
WHOSE CONTRIBUTIONS TO A CANDIDATE EXCEED $200 (IN TOTAL) PER CALENDAR YEAR.
Please confirm the following statements are true (by checking the space provided):
___I am a citizen or permanent resident in the United States and affirm that I am
making this contribution via personal/corporate credit or debit card for which I
have a legal obligation to pay. I am over 18 years of age.
Occupation/Title___________________________________________
Employer___________________________________________________
Name_______________________________________________________
Address____________________________________________________
City/State/Zip_____________________________________________
Phone______________________________________________________
Email______________________________________________________
___Please check here if you would like to receive Winters' Weekly by email.
We are unable to accept corporate checks and contributions from foreign nationals
are prohibited. Partnership checks are welcome, but please state how to
attribute contributions among partners. Please make checks payable to:
Citizens for Dave Winters
3444 N. Main Street, Suite 100
Rockford, IL 61103
Your generosity is appreciated!
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