NO SPECIAL INTEREST
DOLLARS ACCEPTED!

If you want to help TAKE BACK AMERICA,
we need your immediate contribution. See below:
 
Use this form to make an online donation.
Prefer to DONATE BY MAIL or PHONE? Click Here
Federal law requires us to use our best efforts to obtain and report the name, address, employer, and occupation for each individual whose contributions aggregate in excess of $200 during a campaign cycle.
( * = required field )
First Name:  *  
Last Name:  *  
ADDITIONAL INFORMATION
Required:   *    This contribution represents my/our personal funds and is not drawn from an account maintained by an incorporated entity.  
Employer:   * 
Occupation:   * 
Joint Contribution:   This contribution is from a joint account for which both contributors are signers. (Please provide Spouse Name/Employer/Occupation below if joint contribution.)  
Spouse Name:
Spouse Employer:
Spouse Occupation:
Messages:
Amount ($):  *  
$25.00   Level 7   
$100.00   Level 6   
$200.00   Level 5   
$500.00   Level 4   
$1000.00   Level 3   
$2000.00   Level 2   
$2400.00   Level 1   
   [You may insert your donation amount here instead of using one of the above amounts.]

Tell A Friend

Bookmark and Share


Maddox for Congress • P.O. Box 2212 • Rogers, AR 72757 • Phone: 479-790-7296 • Email: MaddoxForCongress@gmail.com

© Copyright 2010 - Maddox for Congress, All Rights Reserved

Paid for by Maddox for Congress