Take Action - Eric Gioia for Public Advocate

First Name*

Last Name*

Email*

Phone*

Street*

Street 2

City*

State/Province*

Zip/Postal Code*

Home Address

Same as BILLING address

Home Street*

Home Street 2

Home City*

Home State*

Home Zip/Postal Code*

Business Address

Same as BILLING address

Business Street*

Business Street 2

Business City*

Business State*

Business Zip/Postal Code*

Occupation*

Employer*

Cardholder Name
(exactly as it appears on your card)*

If your personal credit card billing address is not your home address, please explain why

Event contribution is for (if applicable):

If a contributor has business dealings with the City as defined in the Campaign Finance Act, such contributor may contribute only up to $250 for city council, $320 for borough president and $400 for mayor, comptroller or public advocate. Contributions from persons doing business with the City also will not be matched with public funds.

The doing business contribution restrictions only apply to contributors listed in the City’s doing business database. If you would like more information, or to check if you are in the City’s doing business database, please go to the Campaign Finance Board’s website.

Please indicate whether you have business dealings with the City

If yes, please complete the information below:

City Agency/Agencies Name

Agency Address

Agency City

Agency Zip

Doing Business Entity

Business Category

Billing Address

Home Address

Business Address

Event contribution is for (if applicable):