Thank you for contributing to the Vicki Barnett for State Representative campaign.  Please fill in and print the form below and enclose it with your donation check.

How to print this form: Use your web browser's Print command [Ctrl + P for Windows, Command + P for Macintosh] to print out this form and mail it to the address at the bottom of the form.
Elect Vicki Barnett Campaign Contribution Form

Amount of Contribution:

$

Please make checks payable to:
 Elect Vicki Barnett Committee

No Corporate Checks Please
[corporate contributions are illegal]

State of Michigan Campaign Laws require the following  information to be submitted with any donation. It is used to satisfy the requirements of the campaign disclosure laws. Corporate Contributions are not allowed by State Law.
Name:  
Address:  
Address 2:  
City:  
State:  

Zip:

  
Phone:  

IMPORTANT NOTE: If you are donating over $100 [and we hope you are :)] campaign contribution laws require that any contribution of $100 or more requires the disclosure of the donor's type of employment and name and address of employer.

Your Occupation:  
Name of Your Employer:  
Employer Address:  
Employer City:  
Employer State:  

Zip:

  

Please Mail your contribution with the filled out form to:
     Elect Vicki Barnett Committee
     29312 Orchard Lake Rd.
     Farmington Hills, MI 48334