Please complete the following information below to ensure transparency and satisfy campaign finance and reporting laws. All fields are required. After submitting the form, you will be taken to our donation page on the Coinbase platform.
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 the employer and describe your occupation.
Contributions are not tax deductible for income tax purposes, and corporate contributions cannot be accepted; An individual or non-multicandidate PAC without Mega PAC status (using non-corporate/non-union funds) may contribute up to $5,300.
By clicking “Submit”, you are certifying that:
You are an individual, you are a U.S. citizen or lawfully admitted permanent U.S. resident ("green card" holder);
This contribution is made from your own funds and will not be reimbursed by any other person or entity;
This contribution is not made from the treasury funds of a corporation, labor union, or national bank or from any person or entity who is a federal contractor;
You understand this donation will be reported as an in-kind contribution or as a miscellaneous income.
Paid for by Brianna Westbrook for Arizona.
Brianna Westbrook for ArizonaPO Box 36414 • Phoenix, AZ email@example.com
CONTACT TEAM BRIANNA