Miami-Dade Democratic Party

First Name

Last Name

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Billing Address

City

Postal code

Email

Phone

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Employer

Occupation

Law requires we ask for your employer and occupation. If you don't have an employer or are retired, put N/A, and if you are self-employed put "self-employed" in employer and describe your occupation.

This is a contribution from a business.

Contributions are not tax deductible.

Amount

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Credit card number

I understand that my payment is being made to Democracy Engine, who accepts the responsibility of distributing the funds to my designated recipient(s). My card or bank statement will show a payment to “Democracy Engine” and if there are any issues or discrepancies with the payment or I wish to revoke the payment, I can contact Democracy Engine at [email protected].

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