Congressional Black Congress Political Action Committee

I am ready to help the CBC PAC with my contribution of:

$250

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$1000

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Other Amount: $

Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and employer of individuals whose contributions exceed $200 in a calendar year. To help us comply with this law, please provide all of the following information.

Name
Address
City
State	Zip Code
Phone
Email
Visa or MasterCard Number
Expiration Date	/
Occupation
Employer

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Eligibility

In order to comply with Federal Election Commission requirements, we must confirm that the following statements are true and accurate for all on-line contributors. Please click on the box before each statement that applies to you. Your contribution cannot be accepted unless each box is checked.

	This contribution is made knowingly and voluntarily from my own funds.
	I am not a government contractor, nor am I a foreign national who lacks permanent resident status in the U.S.
	This contribution is made on a personal credit card for which I have the legal obligation to pay.
	This contribution is not made from the general treasury funds of a corporation, labor organization, or national bank.

Your contribution will entitle you to CBC PAC membership. Your contribution will be used in connection with federal elections and is subject to the limitations and prohibitions of the Federal Election Campaign Act. The CBC PAC can accept individual contributions of up to $5,000 per calendar year to our federal account.

Contributions to the CBC PAC are not deductible as charitable for Federal Income Tax Purposes.