Miami-Dade Democratic Party

First Name

Last Name

Country

Billing Address

City

Postal code

Email

Phone

Send email updates

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

$200 $500 $750 $1,250 $2,000 $2,500 $5,000 Other $

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].