Online Contributions

Kentucky's 5th Congressional District

Home

Online contributions to the Holbert Campaign

Contribution form

Thank you for your contribution to the Jim Holbert for Congress campaign. Maximum election campaign contribution amounts are prescribed by Federal Law/. The Jim Holbert for Congress committee designates all contributons made after May 20, 2008 as general election contributions.

Contributions to the Jim Holbert for Congress committee are not tax deductible.

Any area with an asterisk (*) is required.

*First Name:
*Last Name:
*Address Street 1:
Address Street 2:
*City:
*Zip Code:	(5 digits)
*State:
Phone:
Email:
*Occupation (Job Title):	Note: If not employed, enter "NONE".
*Employer:	Note: If self-employed, enter "SELF-EMPLOYED". If not employed, enter "NONE."
*Contribution Amount:
*Other Amount:
*Credit card:
*Card Number:
*Expiration Date:
Card Security Code:	Required if your card has a three digit code on reverse side.
*Name as it appears on the card:
	*I authorize the Jim Holbert for Congress committee to charge my card for the amount indicated.
	I agree
	*Federal law requires contributors to confirm that the following statements are true. If you cannot confirm each statement, you are not eligible to contribute to the Jim Holbert for Congress Committee. 1.This contribution is made from my personal funds and not the funds of a corporation or another person. 2. I am a United States citizen or a lawfully-admitted permanent resident. 3. I am not a federal government contractor. 4. I am at least 18 years of age. By my check below, I confirm that each of the above statements are true, and that all information furnished by me on this form is true and accurate.
	I confirm