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SteveFoleyforCongressDonationForm

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					Enclosed is my contribution, made payable to Steve Foley for Congress, in the amount of:

____ $2,500 ____ $1,000 ____ $500       ____ $100    ____ $50   Other $ _________

Name: _________________________________________________________
Address: _______________________________________________________
City, State, Zip __________________________________________________
Phone: _________________________________________________________
Fax: ___________________________________________________________
Email: _________________________________________________________
Occupation: _____________________________________________________
Employer: ______________________________________________________

Charge my (circle one): VISA   Master Card   Discover   AMEX

Card #: ________________________ *Security Code: ____ Exp. Date: ______

Signature: ________________________________________________________

*Security Code is a 3-digit number for VISA, MC & Discover, a 4-digit number for AMEX

Make checks payable to: “Steve Foley for Congress” and mail to:

                                Steve Foley for Congress
                                 7108 Katella Ave. #245
                                    Stanton Ca 90680

                       THANK YOU FOR YOUR SUPPORT!

				
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