Print-N-Mail Contribution Form

Please complete this form, print it out, and mail to:

Committee to Elect Mike Hihn
13508 - 37th Ave. S.
Tukwila, WA 98168-3933

Thank you!

Name
Address
Apt. #
City, State
Zip
Email
Phone
Employer and occupation information is required by state law, for reporting to the Public Disclosure Commission, for aggregate contributions of $100 or more.
Occupation
Employer
Name
Employer
City,State
Check enclosed, "Committee to Elect Mike Hihn"
Payment by Credit Card, will be "Politics Online" on your statement.
 Credit Card Number
 Credit Card Expires

Contribution Amount: (Maximum is $1200 each, Primary and General.)
$1200   $500   $250   $100   $50
$25    $10    $5    other


Signature (if credit card) X______________________________