Donation Form

All information below is required in order to properly file with the State Board of Elections.

Full Name: ______________________________________________________________________________

Street Address: _________________________________________________________________________

City: _________________________________________  State: _______________  Zip: ___________

Phone Number: _______________________________________

Email Address: __________________________________________________________________________

Place of Employment: ____________________________________________________________________

Job Title: ______________________________________________________________________________

Please make donations payable to and mail to:

Friends for Mike Bell
PO Box 229
Edinburg, IL 62531

Donation Amount: $_________________________


A copy of our report filed with the State Board of Elections (or will be) available on the Board’s official website ( or for purchase from the State Board of Elections, Springfield, Illinois.

O: 302.751.BELL |C: 217.820.0424 |E: |W: