Is this donation on behalf of a company?(Required) No Yes Is this donation on behalf of a political committee?(Required) No Yes HiddenEntity DonationNOTE: Before making a contribution to a ballot question committee pursuant to codified law, an entity (company) has certain information filing requirements with the SD Secretary of State. CLICK HERE to review the codified law requirements. CLICK HERE to download the Ballot Question Statement and return that with your contribution to us via mail. Mail that completed form and your contribution to: SDPRLCA 6390 Long View Rd Rapid City, SD 57703HiddenEntity DonationNOTE: Before making a contribution to a ballot question committee pursuant to codified law, an entity (company) has certain information filing requirements with the SD Secretary of State. CLICK HERE to review the codified law requirements. CLICK HERE to download the Ballot Question Statement and return that with your contribution to us via mail. Mail that completed form and your contribution to: SDPRLCA 6390 Long View Rd Rapid City, SD 57703HiddenPerson DonationAmount(Required) $5,000 $2,500 $1,000 $500 $250 $100 $25 Custom Custom Amount(Required) Payment Method(Required) Check or Cash Payment Online Name(Required) First Last Email(Required) Phone(Required)Billing Address(Required) Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Donation Subtotal $0.00 Credit Card(Required) Total Credit Card Processing Fee Price: $0.00 A copy of this form will be emailed to you after you submit. Please print a copy of the PDF and mail your payment to: SDPRLCA 6390 Long View Rd Rapid City, SD 57703HiddenAuthorized Signature HiddenDate Δ
