PAC Request and Disbursement Form

Required field(s) are indicated by an *.
Please include name, party affiliation, district, and state
For Example: "Doe for Congress"
* Check Due Date / / (MM/DD/YYYY)
If check must be sent to an address other than the one listed above, please use fields below.
For Example: "Doe for Congress"

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Legislative Updates

This is using the area "Legislative Updates" in the "Template" type.