Victory Passport

Billing Information

First Name *

Last Name *

Street *

Street2

City *

State *

Zip *

Email address *

Phone *

My home and billing address are the same.

Mailing Information

Street *

Street2

City *

State *

Zip *

Payment Information

Card Number *

Month *

Year *

CVV *

Card type *

Employment Information

Federal law requires us to obtain and report your occupation and the name of your employer.

If you are retired please type "Retired" and if you are not employed please type "NA" in the boxes below.

Employer Name *

Occupation *

By clicking "Contribute" I certify that the following statements are true and accurate:

I am a United States citizen or an individual lawfully admitted with permanent resident status (e.g., a "green card holder").
This is my personal credit card and this contribution is made from my own personal funds, not corporate, foreign national, or labor union funds.
I will not be reimbursed by anyone for this contribution.
I am not a federal government contractor.

Contributions are not tax deductible as charitable contributions for federal income tax purposes. Federal law requires us to obtain and report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 per election cycle. Contributions by corporations, foreign nationals (non-green card holders), labor unions, federal government contractors, and minors under the age of 18 are prohibited.