Mayor Mozena for L.A.

Contributing to a Better Future for L.A.

Contribute by Credit Card

The Los Angeles City Ethics Commission requires us to report the name, mailing address, occupation, and employer's name of each individual who contributes to the campaign.*Required fields in red

Contributor:

First Name
Last Name
Middle Initial
Title

Spouse: (only necessary if making a joint spousal contribution)

First Name
Last Name
Middle Initial
Title

Contact Information:

Street Address
Address (cont.)
City
State
Zip
Occupation
	(You should state if you are a student, a homemaker, self-employed, retired, or unemployed.)
Employer
	(If self-employed, enter company name. otherwise enter N/A if not applicable.)
Spouse's Employer
	(If self-employed, enter company name, otherwise enter N/A if not applicable.)
Work Phone
	(If not applicable, please enter N/A.)
Home Phone
FAX
E-mail

Payment Information:

Amount of Donation
Credit Card
Cardholder Name
Card Number
Expiration Date	(month/year)

This contribution is drawn on my personal credit card, represents my personal funds, and is not drawn on an account maintained by an incorporated entity.
The maximum an individual may contribute is $1,000 ($2,000 per couple). Corporate and foreign national contributions are not permitted under The Los Angeles City Ethics Commission. Contributions to Mozena are not deductible for federal income tax purposes.
If you have not met the maximum donation, may a representative of the Mayor Mozena Committee contact you a later date for additional funding? Yes No
Even if you have met the maximum donation, there are special circumstances where contribution limits may be lifted by the City Ethics Commission. If those circumstances apply in your case, may we contact you for a possible additional donation? Yes No
In-kind (non-monetary) contributions of goods and services can also be provided to the "Mayor Mozena Campaign". Examples include: Food and beverages for fund raisers; printing and copying of mailers; and professional legal or accounting services. Please contact the Mayor Mozena Committee if you are interested in using this contribution method.
When you click the "Submit Contribution" button, the information you entered above will be submitted to our secure server. Your personal information will be encrypted and secure.