Individual Monthly

Your credit/debit card will be charged $5 each month.

1. Amount

$5.00

2. Your information

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First Name

Last Name

Country

Billing Address

City

Postal code

Phone

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.

Contributions are not tax deductible.

3. Payment information

Credit Card

Contribution rules
Texas Latino Conservatives PAC only accepts contributions from individuals made with personal funds or from political action committees. By using this form, I certify that my contribution complies with this rule.

I confirm that the above statements are true and accurate.

$ 5.00

paid monthly