Maine Innkeepers Association PAC Contribution Form
Name:
Property:
Address 1:
Address 2:
City/State/Zip:
Phone:
Fax:
Email:
Contribution Amount:
$100.00
$75.00
$50.00
$25.00
Other $
Payment Method
Check
Visa
Mastercard
Discover
Credit Card Number
Credit Card Expiration
123
1
2
3
4
5
6
7
8
9
10
11
12
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
