Name:
Email Address:
Address
City
State
Zip Code
Country
Phone
Email
Employment Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of employer of individuals whose contributions exceed $200 in an election cycle.
Employer:
Occupation:
Amount:
Other:
Credit Card:
Credit Card Number:
Expiration Date:
Card (CVV) Code:
Legal Compliance
1. I am a United States citizen or legal permanent resident of the United States.
2.This contribution is not made from the general treasury funds of a corporation, labor organization or national bank.
3.This contribution is not made from the treasury of an entity or person who is a federal contractor.
4.The funds I am donating are not being provided to me by another person or entity for the purpose of making this contribution.
5. I am at least 18 years of age.
Additional Information
Cell Phone:
Home Phone:
Office Phone:
If you would prefer to contribute by mail, copy this form and send a check to:
Rozzy Shorter 4 Houston
Campaign P.O.Box 262061
Houston, TX 77207
Pol. adv. pd. for by the Rozzy Shorter 4 Houston Campaign. Political contributions are not tax deductible & corporate contributions are prohibited. Houston City Ordinance, Chapter 18 defines contributions limits at $5,000 per individual and $10,000 per PAC per election cycle. Individuals listed as Prohibited Campaign Contributors or those in "blackout" due to a consideration of a contract with the city may not contribute, per Code of Ordinances, Chapter 18, Section 36(b).
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