Esau Herrera for Assembly 2016

Your support and donation is greatly appreciated.

Checks (payable to "Esau Herrera for Assembly 2016") may be mailed to the following address:

Esau Herrera for Assembly

2530 Berryessa Rd, No. 145

San Jose, CA 95132

A secure online donation with your credit card may be made using this page.

Contributor

First Name

Last Name

Street Address

City

State

Zip

Country

Phone

Employment

We are required to use our best efforts to collect and report your occupation and employer.

Please do not leave blank or enter 'N/A'.

EmployerIf self-employed, enter 'self'; if unemployed enter 'none' or 'retired'.

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

Legal Compliance

I confirm that the following statements are true and accurate:

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.
I am making this contribution with my own personal credit card and not with a corporate or business credit card or a card issued to another person.
I have read and accept the Democracy Engine Terms of Service, Privacy Policy, and Refund Policy.
I am at least eighteen years old.

Recipients & Amounts

Esau HerreraDemocrat for CA State Assembly (District 27)
$
TOTAL
$

Make this a recurring donation …

That repeats

Until

donations have been made

Stopping after

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

By clicking the donate button below, I acknowledge that my payment is being made to Democracy Engine, who accepts the responsibility of distributing the funds to my designated recipient(s) in accordance with applicable campaign finance laws. My card or bank statement will show a payment to “Democracy Engine” or “DEMENG” 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. Democracy Engine will charge each recipient an applicable service fee.