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Cooper For Congress Committee

  Contribute Online

To Contribute Securely Online: All transactions are processed securely through PayPal and a PayPal account is not required to process the transaction. The campaign has a legal obligation to collect certain information from you when you make a contribution according to the Texas Ethics Commissions reporting standards. Please fill out the fields on this page and then continue to make your contribution on the next page through PayPal.

Or, to download a form and contribute by mail, fax, or email, please click here and provide us with the requested information.
(Click here for Donation Information Form)

  Personal Information
 

Title:

First Name:

Middle Name:

Last Name:

Suffix:

Email:

Home Phone: 123-456-7890

Home Address:

Work Phone: 123-456-7890

Alternate Address:

Fax Phone: 123-456-7890

Country:

 

Mobile Phone: 123-456-7890

 

City:

State:

Zip/Postal:

 

 

  Employment Information
 

Employer:

Occupation:

Federal law requires us to make our best efforts to also collect and report the occupation and name of employer of individuals whose contributions exceed $200 in a calendar year. If you are not employed enter NONE in the employer and occupation boxes.

  Contribution Amount
 

Please make a one-time contribution below.

Amount:

 $25.00

 

 $50.00

 

 $100.00

 

 $500.00

 

 $1,000.00

 

 $2,400.00

 

    $

Please make a monthly sustaining contribution below.

Please note, this donation will be debited directly from your credit card/PayPal account each month.

Number of Months:

 

Amount:

 $25.00

 

 $50.00

 

 $75.00

Monthly Contribution will begin

 

 $100.00

 

    $

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  Legal Compliance
 

 

I affirm that the following statements are true and accurate:
All online contributors must confirm that the following statements are true  and accurate. Your contribution cannot be accepted unless each statement applies  to you. If you are not able to affirmatively answer each question, you are not  eligible to make an online contribution to Cooper For Congress Committee.
1. This contribution is made from my own funds and not those of another.
2. This contribution is not made from the general treasury funds of a  corporation, labor organization or national bank.
3. I am not a Federal government contractor.
4. I am not a foreign national who lacks permanent resident status in the  United States.
5. I am at least 18 years of age.
6. This contribution is made on a personal credit or debit card for which I  have the legal obligation to pay and is made neither on a
    corporate or business  entity card nor on the card of another


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