CRUZ FOR PRESIDENT CONTRIBUTION FORM

$10,800 Couple: ($5,400 per primary and $5,400 per general election cycles)

$5,400 Individual: ($2,700 per primary and $2,700 per general election cycles)
$2,700 Individual

$1,000 Individual

$500 Individual

Name:__________________________________________________________________________________________________________________________
Address:____________________________________________________ City, State, Zip:________________________________________________
Home Phone:___________________________ Office Phone:___________________________ Cell Phone:___________________________
Email:_____________________________________________________ Fax:_______________________________________________________________
Employer:_____________________________________________________ Occupation:_________________________________________________
Spouses Employer:___________________________________________ Spouses Occupation:_____________________________________
Contribution Referred By (if applicable): _________________________Barton/FBTX0046_____________________________
Enclosed is my check payable to Cruz for President or please charge my: Amex Discover MC Visa

Total $:________________________________ Cardholder Name:_________________________________________________________

Card Number:____________________________________________________ Expiration Date:_____________ CVV:____________
Required Signature(s): I certify this contribution is drawn on my personal checking account or credit card, represents my personal funds, and is not
drawn on an account maintained by a corporate entity:

__________________________________________________________________

__________________________________________________________________

Signature of Contributor

Signature of Spouse (if joint contribution)

TO CONTRIBUTE: Please mail form to Cruz for President,

P.O. Box 25384, Houston, TX 77265
The maximum contribution an individual may make to Cruz for President is $5,400 ($2,700 to the primary election; $2,700 to the general
election). A couple may contribute up to $10,800 from a joint account as long as both individuals sign the check or sign above. A multicandidate
federal PAC may contribute up to $10,000 ($5,000 to the primary election; $5,000 to the general election).
Contributions to Cruz for President are not deductible for federal income tax purposes. Contributions from corporations, foreign nationals and
federal government contractors are prohibited. Federal law requires us to use our best efforts to collect and report the name, mailing address,
occupation and name of employer for each individual whose contributions exceed $200 per election.

Paid for by Cruz for President