Make checks or money orders out to Ryon for Congress.  Please print and use the form below when mailing a donation:

DAVID RYON FOR CONGRESS

Donation Form: Please print this form and mail it with your donation

Federal law requires political committees to report the name, mailing address, occupation and name of employer for each individual whose contributions total more than $200 in a calendar year.

NAME:__________________________________________________________

PHONE NUMBER: (_____)_______-__________

ADDRESS:__________________________________________________

CITY:___________________________________________________

STATE:______________ ZIP:____________________

E-MAIL ADDRESS:_________________________________________

NAME OF EMPLOYER______________________________________________

OCCUPATION:________________________________________

Credit Card Information:

Card Type: (circle one) ___ VISA ___ MASTERCARD ___ AMERICAN EXPRESS ___DISCOVER

TOTAL DONATION: $_______________________

Card Number:____________________________________________

Card Verification Number ( three digit number on back of card):___________________________________

Expiration Date:__________________________________________

Name as it appears on the card:________________________________

Signature:______________________________________________

MAIL THE FORM TO:

Ryon for Congress

5035 Magnolia Blossom Blvd.

Columbus, OH 43230-4068

David@RyonforCongress.com

* Under FEC rules, no individual may give more than $2400 per election contest. The primary election and general election are considered separate contests for contribution purposes. A husband and wife may each give the maximum for individual contributors.

1: I am a United States citizen or a permanent resident. 2: My decision to contribute is made knowingly and voluntarily from funds owned or controlled by me and is not made from the proceeds of a gift, the purpose of which was to provide funds to be contributed. 3: This contribution is not made from the general treasury funds of a corporation, labor organization or national bank. 4: This contribution is not from a federal contractor. 5: The funds I am donating are not being provided to me by another person or entity for the purpose of making this contribution. 6: I certify this is my personal credit card not funded by a prohibited source. Please initial below:

Initials:_______