Donate by Check

Type in your information, then print this page using the button in the upper left corner. Please make check payable to LCDC. Mail the check and this form to:

Lebanon County Democratic Committee

PO Box 1128

Lebanon PA  17042

First Name
Last Name
Phone
E-mail
Street
City
State
Zip
Country
Occupation
Employer
	I confirm that the following statements are true and accurate. I am a United States citizen or a permanent resident alien. This contribution is made from my own funds, and funds are not being provided to me by another person or entity for the purpose of making this contribution. I am making this contribution with my own personal credit card and not with a corporate or business credit card or a card issued to another person. I am not a federal contractor. I am at least eighteen years old.

Donation Amount

$50	$75	$250	$2,000
$25	$100	$1,000	Other: $