Contributor

First name

Last Name

City

state

zip / post

Email address

Phone Number

Employment

To comply with Federal law, we must use best efforts to obtain, maintain, and submit the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 per calendar year
Employer
Occupation

amount

$15	$50	$250	$2,300
$25	$100	$1,000	Other: $

Credit Card

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card number

expiration

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Legal Compliance

Check this box to confirm that the following statements are true and accurate:

I am a United States citizen or a lawfully-admitted permanent resident.
I am at least 16 years old.
This contribution is not made from the general treasury funds of a corporation, labor organization or national bank.
This contribution is not made from the funds of a political action committee.
This contribution is not made from the treasury of an entity or person who is a federal contractor.
This contribution is not made from the funds of an individual registered as a federal lobbyist or a foreign agent, or an entity that is a federally registered lobbying firm or foreign agent.
The funds I am donating are not being provided to me by another person or entity for the purpose of making this contribution.

Burlington County's Resource & Relocation Guide
I am pleased to announce that BCCOC & the Burlington County Board of Freeholder’s have partnered to produce the 1st Resource & Relocation Guide for residents & perspective residents. We have contracted with Village Profile Magazine to produce the publication. Don’t wait…advertising is limited. Call Bob Cleaver, our sales associate today (610 -53