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Check Contribution Form

Committee Name: Sayles For Montgomery County
Candidate Name: Laurie-Anne Sayles

Checks may be mailed to the following address: 14203 Georgia Avenue #203, Silver Spring, MD 20906

*Please complete and review this form in its entirety

Are you a Montgomery County resident?

I understand that State law and County regulations require that a contribution be in my name and be from my own funds.  I hereby affirm that this contribution is being made from my personal funds, is not being reimbursed in any manner, and is not being made as a loan; in addition, in the case of a credit card contribution, I also hereby affirm that this contribution is being made from my personal credit card account, billed to and paid by me for my personal use, and has no corporate or business affiliation.

Also, by signing I affirm that I understand and agree to these rules for public financing:  1) This contribution is made in my name and from my own funds and is not being reimbursed in any manner; 2) this contribution is not made from the funds of a political action committee, labor organization, state or local party central committee, sole proprietorship, LLC, or LLP; 3) in case of a credit or debit transaction the transaction is made on a personal credit or debit card for which I have the legal obligation to pay, and is not made either on a corporate or business entity card or on the card of another person; 4) I certify that I have not made individual aggregate contributions to Sayles for Montgomery County of more than $250 for the election cycle; 5) I certify that the information provided is accurate and truthful.

Thanks for submitting!