Contact Information * required fields
Prefix
First Name *
Middle Initial
Last Name *
Suffix
Address *
Address 2
City *
State *	Armed Forces Americas Armed Forces Canada/Europe/Middle East Alaska Alabama Armed Forces Pacific Arkansas American Samoa Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Northern Mariana Islands Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Palau Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming
ZIP *
Email *
Phone
For your protection: The address you provide should be the same as the billing address of your credit card.

Employment Information
Occupation *
Employer *
Federal Election Law requires political committees to report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year.

Contribution Amount
One Time Donation		Monthly Donation

Credit Card Information

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Card Number
Expiration	01 02 03 04 05 06 07 08 09 10 11 12 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032
Card Security Code		What is CSC?
	(Not required for American Express)

Please Confirm
	If you understand and comply with the statement below please check the box. By checking this box, I certify that: 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, labor union, or national bank; 3) I am a U.S. citizen or lawfully admitted permanent U.S. resident

Contributions to the Allen West Guardian Fund are not deductible as charitable contributions for federal income tax purposes. Federal law requires political committees to use their best efforts to request, obtain and report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year. The Allen West Guardian Fund is a federal PAC. Contributions are limited to $5,000 per individual per calendar year. Contributions from corporations, labor unions, foreign nationals, and federal government contractors are prohibited.