Donation Form  

Contribution Mail Form 
Please print this form, complete the following information and mail your contribution to:

Lisa Atkins for Congress
P.O. Box 39
Litchfield Park, AZ  85340-0039

(623) 535-0809


Name_______________________________________________

E-mail_______________________________________________

Address_____________________________________________

City____________________________ State____ Zip________

Phone (_____) _____ - ________

Occupation__________________________________________

Employer____________________________________________

Amount $_______.____

___  My check is enclosed.

___  Please charge my credit card. 
        (circle one:   Visa    MasterCard  AmEx)

Card Number____________________________________________

Expiration Date ________  / ________

Signature __________________________

Contributions by check should be made payable to Lisa Atkins for Congress, 
P.O. Box 39, Litchfield Park, AZ  85340      
Tel: 623-535-0809  Fax 623-535-0969
E-mail Lisa@LisaAtkins.com
Paid for by Lisa Atkins for Congress 
www.LisaAtkins.com 
Contributions are not deductible as charitable contributions for federal tax purposes. Federal law limits contributions to $1,000 per individual. Married couples drawing on joint bank accounts may donate $2,000. 


 
 
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