Philip Fortunato For OIC - Online Contributions by eFundraising Connections

1 Contribution Have an eFundID? Login

$50
$100
$250
$500
$1200
$2400
$4800

(Couples Only)
$ Other

2 Personal Information

Phone

First Contributor

First Name

Last Name

Company Name

Company Type

Responsible Officer First Name

Responsible Officer Last Name

I agree to the following statements:

Certification that Contribution is Not From a Foreign National
I certify that the entity making this contribution is not organized under the laws of, and does not have its principle place of business in, a foreign country. This contribution is not financed in any party by a foreign national, and foreign nationals were not involved in making decisions regarding the contribution in any way.

I, the Authorized Agent listed above, certify that the entity is making this contribution. This contribution is being made, and this certification is being submitted, as of today.