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Please enter the following details about your employer:
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Employer

Occupation

Business Street Address

Apt / Suite / Floor (optional)

City

State

ZIP

Are you an owner, principal officer or senior manager of an organization that does or is proposing to do business with the City?

Yes

No

If a contributor has business dealings with the City as defined in the Campaign Finance Act, such contributor may give only up to $250 for city council member, $320 for borough president, and $400 for mayor, public advocate or comptroller.

Find out the rules on contributions from people doing business with the City of New York

Please enter the following personal information:
All fields are required unless otherwise noted.

First Name

Last Name

Residential Street Address

Apt / Suite / Floor (optional)

City

State

ZIP

Email Address

Telephone # (optional)

Is your billing address the same as your residential address?

Yes

No

My credit card billing address differs because:

My card is billed to my work address.

I recently moved.

My card is billed to a P.O. Box or mail drop.

Other.

Although my billing address is different than my home address, the card is paid from my personal funds.

Please enter the following billing information:
All fields are required unless otherwise noted.

Billing Street Address

Apt / Suite / Floor (optional)

City

State

ZIP

Contribute

Contribute

Contribute

Rafael Salamanca

How much would you like to contribute?

What is your current employment status?

Please enter the following details about your employer:
All fields are required unless otherwise noted.

Are you an owner, principal officer or senior manager of an organization that does or is proposing to do business with the City?

Please enter the following personal information:
All fields are required unless otherwise noted.

Is your billing address the same as your residential address?

My credit card billing address differs because:

Please enter the following billing information:
All fields are required unless otherwise noted.

Please enter the following credit card information:
All fields are required.

Contribute

Contribute

Contribute

Rafael Salamanca

How much would you like to contribute?

What is your current employment status?

Please enter the following details about your employer: All fields are required unless otherwise noted.

Are you an owner, principal officer or senior manager of an organization that does or is proposing to do business with the City?

Please enter the following personal information: All fields are required unless otherwise noted.

Is your billing address the same as your residential address?

My credit card billing address differs because:

Please enter the following billing information: All fields are required unless otherwise noted.

Please enter the following credit card information: All fields are required.

Please enter the following details about your employer:
All fields are required unless otherwise noted.

Please enter the following personal information:
All fields are required unless otherwise noted.

Please enter the following billing information:
All fields are required unless otherwise noted.

Please enter the following credit card information:
All fields are required.