August 13, 2015August 31, 2015 by bencowan To make a secure online credit-card contribution, please complete the following form. Required fields are denoted with an asterisk (*). Occupation and employer information is legally required for campaign finance reporting. Personal Information First Name* Last Name* Email Address* Address* Address 2 City* State* AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY ZIP code* Phone Employment Information Campaign finance law requires that we collect occupation and employer information. If retired, a student, or otherwise not employed, please enter "None" for employer. Occupation* Employer* Employer City* Employer State* AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Payment Information Card Number* Security Code* Expiration* 01 02 03 04 05 06 07 08 09 10 11 12 / 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 $10 $25 $50 $100 $250 $500 $1000 $2500 Other amount* $ I would like to make this contribution:* Once. Monthly for the next months. If you would like to contribute by check, please make your check payable to "Friends of Jim Bernard" and mail it to: Friends of Jim Bernard P.O. Box 42307 Portland, OR 97242 You must include your occupation, employer, and employer city & state on your check. Oregon offers an income tax credit to Oregon tax filers who contribute to qualifying state, federal or local political campaigns. The total credit is limited to $100 on a joint return or $50 on a single or separate return. Please see Oregon Secretary of State for details. Contributions or gifts to this campaign are not tax-deductible for federal income tax purposes.