Support Charley Miller, Colorado’s Unaffiliated for 2010 U.S. Senator

This is a form to use if you want to Donate Print send it in with Donation

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Put in Envelope with Donation Check to: CharleyMiller2010, PO BOX 630482, Littleton, CO 80163-0482

SENATE ELECTION CONTRIBUTION FACT SHEET

Unaffiliated U.S. Senate Candidate Charley Miller, I am proud and honored to join you to support your election to the United States Senate. I am enclosing my most generous contribution in the amount of: $________To contribute by personal credit card, I will personally invoice you, you need to send me an email or you email so I can do that. Please email charleymiller2010@gmail.com

ALL CONTRIBUTORS MUST COMPLETE THE BELOW. WE ARE REQUIRED TO REPORT THE NAME, ADDRESS, OCCUPATION AND EMPLOYER OF ALL CONTRIBUTORS.

Full Name: _____________________________________________________________________________

Spouse’s Name (if joint):_____________Spouse’s Sig. (if joint):_______________

Employer: _____________________________ Occupation:__________________________

Spouse’s Employer (if joint): ____________Spouse’s Occupation (if joint):_____

Address: ___________________________________________

City: _________________________

State: ________________ Zip: __________________

Fax: _________________________

Home Phone: ________________________________

Work Phone: _________________________

Email: ______________________________________

Mobile Phone: _______________________

Signature of Contributor: _________________________________________________________

Contributions to Charley Miller 2010 are not deductible as charitable contributions for federal income tax purposes. An individual may contribute up to $2,400 for the primary election and up to $2,400 for the general election. Federal multicandidate PACs may contribute up to $5,000 for each election. Contributions from corporations, labor unions, federal-government contractors, and foreign nationals (nongreen-card holders) are prohibited. *Federal law requires Charley Miller 2010’s best efforts to obtain, maintain, and report the name, address, occupation, and employer of any individual who contributes more than $200 in an election cycle.

Please make checks payable to: “Charley Miller 2010” and send to:

Charley Miller 2010, PO BOX 630482, Littleton, CO 80163-0482

EMAIL: charleymiller2010@gmail.com See charleymiller2010.wordpress.com

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About charleymiller2010

Charley Miller, UNAFFILIATED for the U.S. Senate in 2010 for Colorado, Stop the Insanity, Fix the Economic Mess & End the Free Rides
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