Green Store

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Last Name

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Email

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Employer

Occupation

Employer Country

Employer City

Postal code

Law requires we ask for your employer and occupation. If you don't have an employer or are retired, put N/A, and if you are self-employed put "self-employed" in employer and describe your occupation.

Contributions are tax deductible.

Amount

$25 $50 $100 $250 $1,000 $2,500 Other $

Credit card number

Contribution rules Your contribution of up to $50 may not cost you a dime! Oregon residents may be eligible to claim a $50 tax credit for political contributions, see http://oregontaxcredit.com/ for more info. I confirm that the above statements are true and accurate. I understand that my payment is being made to Democracy Engine, who accepts the responsibility of distributing the funds to my designated recipient(s). My card or bank statement will show a payment to “Democracy Engine” and if there are any issues or discrepancies with the payment or I wish to revoke the payment, I can contact Democracy Engine at [email protected].