Printable Contribution Form

Federal law requires me to use my best efforts to collect and report the name, mailing address, occupation, and name of employer of individuals whose contributions exceed $200 in a calendar year.

Please fill out all the following information. Thank you for your assistance.

First Name	________________________________
Middle Name	________________________________
Last Name	________________________________
Salutation	________________________________
Home Address	________________________________
City	________________________________
State	________________________________
Zip	________________________________
Home Phone	________________________________
Home Fax	________________________________
College or Community Affiliation	________________________________
Occupation	________________________________
Company	________________________________
Business Address	________________________________
Business City	________________________________
Business State	________________________________
Business Zip	________________________________
E-mail Address	________________________________
Signature	________________________________ (if the contribution is from both you and your spouse, both of you must sign here)
Source Code	Web site solicitation
Corporate contributions are prohibited by law.
Please made checks payable to: RICK HUBBARD FOR U.S. SENATE, P.O. Box 1444, Stowe, VT 05672. For further information, please call 802-253-8544.
Contributions or gifts to Rick Hubbard for U.S. Senate are not tax deductible.

Paid for and authorized by:
Rick Hubbard for U.S. Senate P.O. Box 1444 57 Depot Street Stowe, VT 05672
802-253-8544
This is the only official web site of the Rick Hubbard for U.S. Senate Committee. While other web sites might advocate Rick Hubbard's election or the defeat of other candidates, and while they might contain links to this site or republish information or materials that I have made available to the general public, they are not authorized by the Rick Hubbard for U.S. Senate Committee, nor have they been coordinated in any way with the Rick Hubbard for U.S. Senate campaign.