Donation Form – Pay by Check

If you wish to pay by check, simply print this form and mail it to:

Committee to Elect Jenny Kassan

4388 Lorren Dr.

Fremont, CA 94536

Make checks payable to “Jenny Kassan for Fremont City Council 2018”.

Election laws require that donations over $100 require employer and occupation information.

Local election law limits donations to $600 per person.

 

First Name*:

Last Name*:

Address*:

City*:

State*:

Zip Code*:

Phone Number :

Email Address*:

Employer**:

Occupation**:

Donation Amount*:

* Required
** Required if donation is $100 or greater.