MAIL TO: 2001 L St. NW, Suite 600 Washington, DC 20036 Phone 202-955-5500 FAX 202-955-9466 CONTRIBUTION FORM Name _____________________________________________________________________________________________ Mailing Address _____________________________________________________________________________________ City, State Zip ______________________________________________________________________________________ Phone _____________________________________ Email __________________________________________________ * Occupation _________________________________ * Employer_____________________________________________ CLUB FOR GROWTH $________________________ (amount not limited) Please make your personal or corporate check payable to “Club for Growth” □ Please check this box if you are making a corporate contribution Donations may be used for political purposes such as supporting or opposing candidates. No funds will be earmarked or reserved for any political purpose. Contributions from foreign nationals (non-Green Card holders), government contractors and national banks are prohibited. CLUB FOR GROWTH PAC $___________________ ($5,000 maximum per calendar year) Please make your personal check payable to “Club for Growth PAC.” CLUB FOR GROWTH PAC-ENDORSED CANDIDATES Please make your personal checks payable to each of the candidate’s committee. SENATE CANDIDATES HOUSE CANDIDATES Marco Rubio (FL-SEN) $____________ Jim Banks (IN-03) $____________ “Marco Rubio for Senate” $5,400 maximum “Jim Banks for Congress Inc” $2,700 maximum John Fleming (LA-SEN) $____________ Andy Biggs (AZ-05) $____________ “Fleming for Louisiana” $5,400 maximum “Andy Biggs for Congress” $5,400 maximum Ron Johnson (WI-SEN) $____________ Rod Blum (IA-01) $____________ “Ron Johnson for Senate Inc” $2,700 maximum “Rod Blum for Congress” $2,700 maximum Mike Lee (UT-SEN) $____________ Ted Budd (NC-13) $____________ “Friends of Mike Lee” $2,700 maximum “Ted Budd for Congress” $2,700 maximum Rand Paul (KY-SEN) $____________ Warren Davidson (OH-08) $____________ “Rand Paul for $2,700 maximum “Davidson for Congress” $2,700 maximum Senate” Tim Scott (SC-SEN) $____________ Ron DeSantis (FL-06) $____________ “Tim Scott for Senate” $2,700 maximum “Ron DeSantis for Florida” $5,400 maximum Scott Garrett (NJ-05) $____________ “Scott Garrett for Congress” $2,700 maximum Corporate contributions are not permitted to the Club for Growth PAC or to any federal candidate COMPLETE CREDIT CARD FORM ON REVERSE PAYMENT INFORMATION □ Visa □ MC □ AmEx □ Discover Card Number________________________________________________________ Expiration date_________________ Name on Card _______________________________________________________ CVV/Sec. code _________________ PLEASE INDICATE DONATION AMOUNT(S) ON FRONT OF FORM Donations are not deductible as charitable contributions for Federal income tax purposes. Contributions made to the Club for Growth PAC directly will be spent for Club PAC activities and programs as the PAC determines within its sole discretion. Contributions made directly to the PAC will not be earmarked for any candidate. All contributions are voluntary and you may refuse to contribute without reprisal. Contributions from corporations, foreign nationals (non-Green Card holders), government contractors and national banks are prohibited to Club for Growth PAC and federal candidates. *Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and employer of individuals whose contributions to candidates or the Club for Growth PAC exceeds $200 in a calendar year. .