MERCER COUNTY DEMOCRATIC COMMITTEE

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Print and fill out this form. This is not a phishing form. If you are uncomfortable with this form, please contact us at the e-mail below.

New Jersey Election Law requires us to record the following information for all contributions. (Please read our privacy statement below.) While the telephone, fax and email information is optional, it does make it easier to contact you concerning payment and to thank you for your contribution. We DO NOT release telephone, fax, and email information.

Donation to:

 Mercer County Democratic Committee
Donation Amount  __________________________________________________________________
Name __________________________________________________________________
Address: __________________________________________________________________
City, State and Zip : __________________________________________________________________
*Phone Numbers (home and work): __________________________________________________________________
*E-mail : __________________________________________________________________
*Fax: __________________________________________________________________
Occupation: __________________________________________________________________
Employer: __________________________________________________________________
Employer Address: __________________________________________________________________
Employer                 City, State and Zip : __________________________________________________________________

*Optional, but please see privacy statement below

Contributions to the Mercer County Democratic Committee
should be made by check and mailed to:

Mercer County Democratic Committee
421 Crescent Avenue
Mercerville, NJ 08619
 mercerdems@earthlink.net

Please be certain to include all contact, occupation and employer information.

Privacy Policy: The New Jersey Election Law Enforcement Commission (NJ ELEC) requires us to record the name, address, occupation, employer and employer address for all contributions.

Under certain circumstances, this information must be reported to the NJ ELEC. Information provided to NJ ELEC is publicly available and we cannot be responsible for use of that information by anyone other than the Mercer County Democratic Committee. We DO NOT release telephone, fax, and email information. Please contact us at mercerdems@earthlink.net to report any misuse of this information
 

 

 

 

 

 

 

 

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