Jay Beeber for City Council 2019

Please use full legal name and residential addresses only. No PO Boxes or Mail Centers accepted.

Maximum donation is $800 per individual.

Contributor

First Name

Last Name

Street Address

City

State

Zip

Country

Phone

Employment

Campaign finance law requires us to obtain your occupation and employer.

EmployerIf self-employed, enter the name of your business; if unemployed enter 'none' or 'retired'.

OccupationPlease complete even if self-employed; enter 'none' or 'retired' if unemployed.

Legal Compliance

I certify under penalty of perjury under the laws of the City of Los Angeles and the state of California that all of the following statements are true and correct.

I have read and accept the Democracy Engine Terms of Service and Privacy Policy.
I am at least eighteen years old.
I understand that my payment is being made to Democracy Engine, who accepts the responsibility of distributing the funds to my designated recipient(s). My card or bank statement will show a payment to “Democracy Engine” and if there are any issues or discrepancies with the payment or I wish to revoke the payment, I can contact Democracy Engine at support@democracyengine.com.
I am a United States citizen or a permanent resident alien.
This contribution is made from my own funds, and funds are not being provided to me by another person or entity for the purpose of making this contribution.
The contribution is not being made under a false name.
The contribution is not being made under someone else’s name.
The contribution does not cause the contributor to cumulatively or in the aggregate exceed the applicable contribution limit.
The contribution has not and will not be reimbursed.
The contribution is not from a lobbyist or lobbying firm that is prohibited from making it.
The contribution is not from a bidder, subcontractor, principal or underwriting firm that is prohibited from making it.
For an individual contributor, whether the address provided is the contributor’s residence address.
The information regarding the contributor’s address, occupation and employer is correct.

Additional Information

This is a business donation.

Recipients & Amounts

Jay Beeber for City Council
$
TOTAL
$

Payment Method

Credit CardElectronic Check

Select a payment method to continue …

Credit Card

Card Number Four_cards

Expiration Date

Security Code (CVV)

Electronic Check

Account Type

CheckingSavings

Routing (Bank) NumberOmit any dashes or spaces

Retype Routing Number

Account NumberOmit any dashes or spaces

Retype Account Number