Business Leaders United For Boca Raton

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Event Name & Date (if applicable)

Contributors

First Name

Last Name

Company Name (if applicable)

Billing Address 1

Address 2

City

State

Zip

Phone 1

Phone 2

Contribution Amount $

BLU-PAC contributions are not tax deductible. There are no limits on the amount you can contribute to BLU-PAC. BLU-PAC supports or opposes candidates for elective office. BLU-PAC is a separate entity governed by its own Board of Directors and complies with all Florida Election Regulations and reporting procedures.

Sponsored by Business Leaders United for Boca Raton - PC Pursuant to section 106.087(2)(a), Florida Statutes, 1800 N. Dixie Highway, Boca Raton, FL 33432. Not approved by any candidate.

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Contribution Amount

I (we) make this contribution in the form of

NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.

Credit Card Information

Same as Billing Information

Credit Card Type

Mastercard

Visa

Discover

Amex

Credit Card Number

Name on Card	Required
Security Code	Required
Valid Through
Address	Required
City	Required
State
Zip	Required
Phone	Required
Credit Card Email Address

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