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 (elections.il.gov) or for purchase from the State Board of Elections, Springfield, Illinois.

O: 302.751.BELL |C: 217.820.0424 |E: mikebellrep96@gmail.com |W: http://www.mikebell4rep.com

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