DONATIONS

Thank you for considering a donation to my Campaign for St Louis County Councilman in District 2.
Please review my website to determine if I am the right Candidate for you.
You will find I am a straight shooter and will often Communicate through Social Media and Email Lists to stay in touch with your opinions on items I am voting for. Just ask my Mayor/City Administrator
**Please fill out the form below, so we can keep a good record of our donations. Thank You again,
Amy

IF SENDING CHECK PLEASE MAKE IT OUT TO "CITIZENS FOR AMY POELKER"
SEND TO: 3459 MARY ANN CT., SAINT ANN, MO., 63074
DATE
NAME OF CONTRIBUTOR
Street Address
CITY
STATE
ZIP CODE
EMPLOYER/OCCUPATION
DONATION AMOUNT
CONTRACTUAL RELATIONSHIP OVER $500, WITH THE STATE OF MISSOURI?
EMAIL
PHONE #
Paid for by Citizens for Amy Poelker, Rebecca (Becky) Buwalda Treasurer.
All Boxes Must be filled in please.

Sample Picture of all Necessary Information needed

Thank You

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https://www.facebook.com/amypoelker2/

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https://www.facebook.com/ward2amypoelker/