ATA_Truck_PAC_Contribution_TY – Arizona Trucking Association

ATA Truck PAC Contribution

Thank you for registering for the ATA PAC Golf Tournament. Please fill out the form below for your personal contribution to ATA’s Truck PAC to complete your registration.

Please note: Contributions to ATA Truck PAC are not tax deductible for federal or state income tax purposes. Contributions from corporations and foreign nationals are not permitted. Campaign disclosure laws require us to obtain and report a contributor’s name, address, employer and occupation.

Please contact Leslie Hensley at Lhensley@aztrucking.com or 602.850.6001 for additional information.

Minimum contribution $50.00.
Reminder: PAC contributions must be paid with personal funds.

ATA PAC Contribution

Contribution Amount*
By clicking the box below, I verfiy the following statements are accurate and true:*
I verify these statements to be true and accurate.
1. This contribution is made from my own funds and will not be reimbursed by any other person or entity;
2. This contribution is not made from the treasury funds of a corporation or labor union;
3. I am a U.S. citizen or lawfully admitted permanent U.S. resident (“green card” holder).
Attendance*
- I will be attending the event to support ATA Truck PAC
- Unfortunately, I am unable to attend
- Name*
  First Last
- Employer
- Occupation
- Spouse's Name (if joint contribution)
  First Last
- Spouse's Employer
- Spouse's Occupation
- Address
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- Email*
- Phone*
- Billing Details
- Select Credit Card Type:*
  - Visa
  - Mastercard
  - Discover
  - American Express
- Credit Card
  
  American Express
  Discover
  MasterCard
  Visa
  Supported Credit Cards: American Express, Discover, MasterCard, Visa
  Card Number Expiration Date Security Code Cardholder Name
- Total
  $0.00
- Confirm Last 4 of the Credit Card #*
- This field is hidden when viewing the form
  Tax Type
- This field is hidden when viewing the form
  Tax