NCDTC Donation Form

VIA MAIL:

If you would like to donate by check, please CLICK HERE to print our mail-in donation form. After completing the form, please mail along with your check to: New Canaan Democratic Town Committee, P.O. Box 1294, New Canaan, CT 06840.

VIA ONLINE:

To donate by credit or debit card, please fill out the form below. Clicking “Submit Donation” will take you to PayPal to complete your payment. (All fields are required.)

 

Name:*
Address:*
Residential Phone:*
-
E-mail:*
Employer:*
Occupation:*
Are you a lobbyist or the spouse or dependent child of a lobbyist? (please check one)*
I certify that all of the information disclosed and set forth above is true to the best of my knowledge.*
I further certify that I am not a principal of a state contractor or a potential state contractor. I am a United States citizen or a foreign national with permanent resident status. I am 18 yrs of age or older and have provided my residential address. I also certify that this donation is made from my personal funds.*
Amount of Donation*
 $ 

Donations are made securely using PayPal. If you don't have a PayPal account you may use your credit card.