By submitting your campaign contribution, you certify that the following statements are true and accurate:

• By typing my name in the signature field, I am indicating my intent to sign this authorization to make this contribution utilizing the credit card or payment method provided.
• I am a United State citizen or lawfully admitted permanent resident.
• My contribution is made from my personal funds and not those provided to me by another individual or organization for the purpose of making this contribution.
• This contribution is made using my personal credit or debit card for which I have the legal obligation to pay, and not the credit card of another individual or entity.
• I am at least 18 years of age.

State of New Jersey law requires us to collect and report the name, mailing address, occupation and employer of each individual whose cumulative contributions exceed $300 in an election cycle. Contributions are limited to $4,900 per individual or company per election. New Jersey law prohibits entities operating in certain regulated industries (casinos, financial institutions, insurance companies, and utilities) from contributing. Vendors doing or seeking to do business with the State of New Jersey and certain individuals associated with those vendors may also be prohibited from contributing amounts in excess of $300 per election.

Please consult N.J.S.A. 19:44A-20.13 et seq. and Executive Order 117, regarding a vendor that holds or is seeking a contract with the State of New Jersey or its agencies or authorities in an amount in excess of $17,500. Contributions or gifts are not deductible for income tax purposes.