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THE FOLLOWING INFORMATION IS REQUIRED:

Name:
Address:
City/State/Zip:
Phone: Fax:
E-mail:
Occupation: ________ Retired
Employer:
‰ Yes, you may use my/our names for endorsement purposes:
Signature(s)
Amount of Contribution:

CREDIT CARD CONTRIBUTIONS:


‰ Mastercard ‰ Visa ‰ American Express
Credit Card #: Expiration Date ___________
If this is a corporate card, by law it will be considered a corporate donation.

Is this a corporate card? ‰ Yes ‰ No Corporation Name: ______________________


Name as it appears on the card:
Billing Address (if different):
Authorized Signature (must be same as name on the card):
Please make checks payable to:
MEG WHITMAN FOR GOVERNOR 2010 EXPLORATORY COMMITTEE
Tax ID #26-4185645 FPPC # 1315455
Kindly send completed form and donation to:
Meg Whitman for Governor 2010 Exploratory Committee, c/o Joanne Davis
6621 E. Pacific Coast Hwy., Suite 140, Long Beach, CA 90803
You may also fax this form to Fax: 562.596.1533 Phone: 562.596.1355
Contributions to Meg Whitman for Governor 2010 Exploratory Committee are limited to $25,900 per donor for the
June 2010 Primary Election. Individuals, businesses, corporations and PAC contributions are permissible. Spouses
and adult children may each contribute by separate check signed by each spouse or adult child or by credit card
authorization signed by each spouse or adult child. Credit card contributions may be accepted but must specifically
identify the card holder, whether personal or business. Contributions from foreign nationals may not be accepted
unless they have permanent residency status in the United States. Under California law, contributors of $10,000 or
more to state or local candidates or committees have their own disclosure requirements. You should consult the Fair
Political Practices Commission website at fppc.ca.gov for further information. Contributions to Meg Whitman for
Governor 2010 Exploratory Committee are not tax deductible.

Fundraiser ID: ______________________________

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