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If you are self-employed, please list the name of the entity that is on your paycheck. Please list your line of work. "Business Person" is not acceptable, please enter the type of business instead.

We respectfully request that Partners of Partnerships and Members of LLC's contribute individually, instead of through their respective business entity.

By clicking on the "Contribute" button you confirm that the following statements are true and accurate:

• This contribution is made from my own funds, and not those of another.
• This contribution is not made from the funds of a corporation or labor organization.
• This contribution is made on a personal credit card or debit card for which I have the legal
obligation to pay, and is not made either on a corporate or business entity card or on the card of another person.
• I am not a foreign national who lacks permanent residence in the United States.
• I am at least eighteen years old.

Contributing by check? Please fill out this donation form and send your contribution to:
Shruti Bhatnagar for Montgomery County
PO Box 722
Silver Spring, MD 20918
Make checks payable to "Shruti Bhatnagar for Montgomery County"

Contributions or gifts are not tax deductible.

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