WSRS PAC Donation Form

Contact Information
Name
First Last
Billing Address*
Street Address Address Line 2 City State ZIP Code
Email*
State law requires that you report information about your employer:
Occupation*
Employer*
City of Employment*
State of Employment*
State
Foreign National Certification*
State law prohibits foreign national financing or involvement in campaign-related contributions. (RCW 42.17A.417).
- I certify that my contribution is not financed in any part by a foreign national, and foreign nationals were not involved in making decisions regarding the contribution in any way.
PAC Donation Amount
- $75
- $100
- $150
- Other Amount
PAC Donation Amount - Other
TOTAL
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Please note: Contributions to the WSRS PAC are not deductible as a charitable contribution for federal income tax purposes. In addition, no portion of any contributions to the WSRS PAC can be deducted as a business expense on your federal income tax returns.

INQUIRIES: Contact the WSRS Executive Director, at 206-956-3621 or admin@wsrs.org.