payment-test-form

The amounts below are merely suggestions. Members are free to contribute more or less than the guidelines suggested. AUSPL makes no distinctions among members based upon the amounts of their contributions to AUSPL PAC, or based upon any decision not to contribute.

Donation Amount:(Required)

$25.00

Price:

$50.00

Price:

$100.00

Price:

$250.00

Price:

$500.00

Price:

$1,000.00

Price:

Enter Donation Amount:(Required)

Name(Required)

First Last

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

Payment Total

Verify this is a Personal Credit Card(Required)

Yes, this is a PERSONAL credit card.

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Occupation(Required)

Employer(Required)

Required information: Federal Law requires AUSPL PAC to use its best efforts to collect and report the name, address, occupation, and employer of individuals whose contributions exceed $200 in a calendar year.