CPoW Contribution Form

Thank you for your desire to help us Honor God, Defend the Family and Restore our Republic with your financial support.

Click the "Donate" button above left to contribute on-line. You will be taken to a secure website for your transaction. If you prefer to mail in your donation The Constitution Party of Wisconsin has provided this form for your use.

Please print this form and fill in the necessary information then mail it to the address below.

Thanks again for your most generous contribution!

Name:

_________________________________________

Address:

_________________________________________

City, ST Zip:

_________________________________________

Phone number:

_________________________________________

I've enclosed a check or money order payable to the CPoW in the amount of:

$_____________

Please charge my credit card for the amount indicated:

$_____________

Name as it appears
on your card:

_________________________________________

Card type:

_________________________________________

Card number:

_________________________________________

Exipres on:

_________________________________________

The Federal Elections Commission and Wisconsin State Elections Board require the following information for all individuals who make contributions in excess of $100 in a calendar year. Corporations are not allowed to make contributions to political parties. Contributions to political parties are not tax deductible.

Name of Employer:

_________________________________________

Address of Employer:

_________________________________________

Type of work:

_________________________________________

Please send your contribution to:

Constitution Party of Wisconsin
P.O. Box 142
Whitewater, WI 53190