Contribution Form www.hundreddollarparty.org Name:______________________________________ Registered as:___________________ Mailing address:_____________________________________________________________ Occupation:___________________ Employer business:______________________________ Contribution $_____________   Make check payable to: Hundred Dollar Party National Committee Mail to: Hundred Dollar Party PMB # 111 1465 Route 23 South Wayne, NJ 07470 Federal law requires political committees to report and use their best effort to collect the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of two hundred dollars in a calendar year. 104.7 (a)(1). 104.7 (b)(1). Contributions will be used in connection with federal elections and are subject to the limits and prohibitions of the Federal Election Campaign Act 102.5(a)(2)(ii)and(iii) Section 6113 of the Internal Revenue Code requires political committees whose gross annual receipts normally exceed $100,000 to include a special notice on solicitations informing solicitees that their contributions are not tax deductible.