C O N T R I B U T I O N

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C H E C K

If you would like to send your contribution by check, please fill out this form, select the "Print Now" button, enclose the printed form and your check in an envelope and send to the address given below.

Should you choose to fill out the form manually, simply print the form first, fill it out and enclose it with your check and mail to the address given below.

Please Make Checks Payable to:
Friends for Ed Via
Mail to:
Friends for Ed Via
10354 Wanchese Way
Ashland, Virginia
23005
* Indicates the information is required.
* I would like to make a contribution of . $
PERSONAL INFORMATION
* First Name:
* Last Name:
* Address 1:
* City:
 * State: Zip:
* Phone:
 E-Mail:
     
* Company Name:
(required by law)
* Company Ph:
* Occupation (required by law):

Authorized by Friends for Ed Via.
Contributions are not tax deductible and all contributions of over $100 made to Friends for Ed Via will be made public.

IMPORTANT: The Political Contributions Credit is available to individuals who make contributions to candidates for state or local political office. The credit is 50 percent of the amount of the contribution, subject to a $25 limit for individuals and $50 limit for married taxpayers filing jointly and cannot exceed your tax liability.