ABC PAC Prior Authorization Form

Yes, I want to help elect Local candidates who share the ABC free enterprise legislative agenda!

I commit to participating in the ABC-TCB PAC Sustaining Member program by signing up for monthly contributions with my personal credit card on the new ABC PAC website.

I agree

I will be making a monthly gift in the amount of:

$

Select corresponding badge level:

Emerging Leader: Green Badge, $50.00

Leadership: Gold Badge, $150.00

Congressional: Platinum Badge, $250.00

Senatorial: Red Badge, $350.00

Presidential: Black & Silver Badge, $500.00

Chairman's Club: Black & Gold Badge, $1000.00

Name

First Name

Last Name

Company Name

Job Title

Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Fax Number

Chapter

Contributions to ABC PAC are not tax deductible for federal income tax purposes. Contributions to ABC PAC are for political purposes. All contributions to ABC PAC are voluntary. You may refuse to contribute without reprisal. The proposed contribution amounts are suggestions; you may choose to contribute more or less, or not at all. ABC will not favor or disadvantage anyone by reason of the amount of their contribution or their decision not to contribute. Federal law requires political committees to report the name, address, occu-pation and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year. Corporate donations are prohibited.

* Monthly Gift Contributors

A record of my gifts will appear on my bank or credit card statement and I can increase, decrease, or suspend my giving by calling the ABC PAC at (202) 595-1814. All gifts provided to the ABC PAC originating as Automatic Clearing House transactions comply with U.S. law.

Please mail your personal commitment to:

ABC-TCB PAC

Associated Builders and Contractors Texas Coastal Bend / RGV Chapter

7433 Leopard St

Corpus Christi, TX 78382