Secure Contribution Form

Use the form below to contribute to Yetta's campaign or click

here to download a contribution form to send through the mail.


Or Contribute with a Credit Card below:






* indicates required fields
Personal Information
* Full Name
* Address:
* City:
* State:
* Zipcode:
* Email:
* Phone:
Employment Information
This information is required by New York City Campaign Finance law.



To comply with Campaign Finance reporting rules and for public disclosure purposes, please indicate whether you are employed, self-employed, retired,

a homemaker, or a student.

* Job Status


If you select "Employed" as your job status it is required to enter your Company Name and

Occupation.
Contribution Information
$15 $100 $1000
$25 $250 $1500
$50 $500 $2750
Other: $


The contribution limit is $2750. Corporations, partnerships, LLPs and LLCs
are prohibited from making a contribution. A Political Committee may not
make a contribution unless it is registered with the NYC Campaign Finance
Board.
Payment Information

* Credit Card: (xxxx-xxxx-xxxx-xxxx)

* Expiration Date:

*Month:    

*Year:    
*Security Code:
(Visa & Mastercard: 3-digit-code or American Express: 4-digit-code)


* Card Type:


Confirm Eligibility

* I confirm that the following statements to be true and accurate:


I understand that State law requires that a contribution be in my name and be from my own funds. I hereby affirm that this contribution is being made from my

personal credit card account, billed to and paid for by me for my personal use and having no corporate or business affiliation; and is not being made as a

loan.


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contributions.pdf112.96 KB