PAC Advocacy Donation Survey

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PAC Advocacy Donation

Pest-PAC is a political committee established by the Florida Pest Management Association, under the laws of the State of Florida for the purpose of providing for the protection, preservation, and furtherance of the private enterprise system and the strong United States of America. Pest-PAC seeks to accomplish this mission by using funds contributed by its contributors and members to make contributions to political candidates seeking state and local office, to other political organizations, and to political parties who have demonstrated their commitment to these rinciples.

Contribution Pledge Amount

1.	Select the amount of your donation.* Select at least 1 response and no more than 1 response.
	$50 $100 $250 $500 $1000
	Other, please specify

2.	Company

3.	Full Name*

Street Address*
Enter at least 4 responses and no more than 5 responses.

Address 1
Address 2
City
State
Zip

5.	Email Address*

6.	Phone Number

Payment Information

Contributions to Pest-PAC, PC are voluntary and are not deductible for income tax purposes.
Please return with personal/corporate check or credit card information to:

7.	Select your payment method.*
	Visa Mastercard Amex Check (Payable to Pest-Pac, PC)

Credit Card Information
Enter at least 4 responses and no more than 4 responses.

Card Number
Cardholder Name
Security Code
Expiration Date
Electronic Signature (Please enter your full name)

Billing Address (if different than above)
Enter at least 0 responses and no more than 0 responses.

Street Address
City
State
Zip

Mail Check Payment to:

PAC - Financial Management
Attn: Noreen A. Fenner
8489 Cabin Hill Road
Tallahassee, FL 32311