Jeff Wagener  Jeff Wagener
for State Representative - 85th District
 Integrity • Ability • Commitment
 Protecting Our Families
 My Record  Preserving Our Neighborhoods  Protecting Our Families
 
 Biography  Issues  News  Make a Donation  Volunteer  Photo Album  Map of this Site  Home

Sign up to receive
updates via email!

 First Name 


 Last Name 


 Email Address

 Zip Code
  
 
 
 Privacy Policy

 
 Get voter forms and information

Get voter forms
and information


 Make a Donation

To send a donation by regular mail
, please type your personal information in the fields below, print out the form, write your credit card information on the printed form, and send your contribution to the Jeff Wagener campaign. Your privacy is assured. Thank you for your support!
    Citizens to Elect Jeff Wagener
    607 Sappington Barracks Road
    St. Louis, Missouri 63125

    314-894-9440   PHONE
     

    Rules for Contributions

    Contribution limits for this office in Missouri are $300 between now and August 3, 2004.

    Corporate contributions are permitted under Missouri law, but companies with a contract with the State of Missouri for more than $300 must identify themselves.

* Required fields are red
Please fill out the required fields that are in red. Then print out the form and complete the remaining information off-line.  

 Contributor
 
Mr. or Ms.   
* First Name   
Middle Initial   
* Last Name     
 
 Spouse or Partner
 
Mr. or Ms.   
First Name   
Middle Initial   
Last Name     
   Contact Information
 
* Street Address   
 
* City   
* State & Zip     
* Home Phone   
Work Phone   
Fax   
E-mail Address   
Occupation   
Employer   
 
Do you have a contractual relation with the state
or any political subdivision?   Yes   No

 

 Payment Information
 
You may now print out this form
and fill in the remaining information off-line

 
 
Rules for Contributions

Contribution limits for this office in Missouri are $550 for any individual or corporation between now and election day.

Corporate contributions are permitted under Missouri law, but companies with a contract with the State of Missouri for more than $500 must identify themselves.

* Donation Amount  $  ______.00
* Check donation  
* Credit Card donation  
 
 Visa     Mastercard   
 
* Credit Card Number     
__ __ __ __   __ __ __ __   __ __ __ __   __ __ __ __
 
* Expiration Date    __ __   __ __
* Name on Card   
 
Enter your credit card billing address if it is different
from the address you entered above
 
* Billing Address   
 
* City   
* State & Zip   
  How did you first hear about the Jeff Wagener campaign?   
 Campaign letter or flyer
 Colleagues at work
 E-mail message
 Friends and family
 On another Web site
 Newspaper or magazine
 Phone call from the campaign
 Radio
 Television
 Other   ________________
 
Are you making this donation to fulfill a pledge that you
previously made to the campaign?   Yes   No

If you do not want us to share your name
with other organizations, please check here

 

 Where to Send Your Contribution
     
    Citizens to Elect Jeff Wagener

    607 Sappington Barracks Road
    St. Louis, Missouri 63125

    314-894-9440   PHONE
     

Thank you for your support!

 

 
Biography    Issues    News    DONATE    Volunteer    Photos    Site Map    Privacy    Legal    Home
 
Contributions to Jeff Wagener are not tax deductible. Paid for by Citizens to Elect Jeff Wagener,
Marlene Treadway, Treasurer, 607 Sappington Barracks Rd., St. Louis, Missouri 63125