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Individual Contributor Certification Form

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I hereby certify and state that all of the information disclosed by me and set forth above on this contributor form is true and accurate to the best of my knowledge and belief.

I certify that I am either a United States citizen or a foreign national with a permanent resident status in the United States.

I certify that I have provided my residential address.

I certify that this contribution is made on my personal debit or credit card for which I have a legal obligation to pay and intend to pay from my own personal funds, is not being reimbursed in any manner, is not being made as a loan, is not an otherwise prohibited contribution, and that payment on this card is not made from the funds of a corporation, labor organization or any other entity.

Click here to read legal definitions.

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