Protect Energy Choice

Individual Donation

PAC finance law requires us to collect your employment information:
Are you retired?*

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If you are employed, what is your occupation?*
Please put N/A if you are retired
If you are employed, who is your employer?*
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Employer City*
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Employer State*
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Business Donation

We’re required by the Public Disclosure Commission to collect the following information:
I certify that the entity Name of entity* , making this contribution is not organized under the laws of, and does not have its principal place of business in, a foreign country. This contribution is not financed in any part by a foreign national, and foreign nationals were not involved in making decisions regarding the contribution in any way.
Amount of Contribution*
Date of Contribution*

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Date
Name of Authorized Agent:*
Date Submitted:*

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Date

Donation*

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Individual Donation