Compass Experiment

Not for external use

Experiment

Contributor

First Name

Last Name

Street Address

City

State

ZIP

Country

Phone

I confirm that the following statements are true and accurate:

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.

Payment method

Credit Card Electronic Check

Card Number Four_cards

Expiration Date

Security Code (CCV)

Account Type

Checking Savings

Routing (Bank) Number(omit any dashes or spaces)

Retype Routing Number

Account Number(omit any dashes or spaces)

Retype Account Number