Bill Ingram

 for

President of the United States

Please print out this page and complete the form at the bottom.  I need this information for reporting to the Federal Campaign Committee (FEC).  Then mail the form along with your check to:

Bill Ingram Campaign Committee, LLC

PO Box 27

Elk Mound, WI 54739

I can only accept checks or money orders from individuals.  The FEC prohibits Presidential Candidates from accepting contributions from; Corporations, Labor Organizations, National Banks, Federal Government Contractors, Foreign Nationals, or Contributions in the Name of Another.

Full Name:_____________________________

Address:_______________________________

City:__________________________________

State:_______        Zip Code:______________

Occupation:____________________________

Name of Employer;______________________

Circle amount of check  $5  $10  $25   Other_______________

                                                                  (Sorry, but it can not be for more than $2,000)

I certify that I am not a Corporation, Labor Organization, National Bank, Federal Government Contractor, Foreign National, or making this Contribution in the Name of Another.

Signature____________________________   Date____________