Piatt County Democrats Donation Form

Complete and return with your check to:

	Piatt County Democrats
	PO Box 572
	Monticello IL 61856


Name : ________________________________________________________


Address: ______________________________________________________


* Phone # _______________________________________________________


*Email : ________________________________________________________
	* We won't share this information




Donate now to Grow your Local Democratic Party -- please make
checks payable to "PIATT COUNTY DEMOCRATS"


(   )  $ 100 Level

(   )  $  50 Level

(   )  $  35 Level

(   )  Other  $________





We at the Central Committee would like to thank-you in advance for your support 
and hope that you will choose to be part of our winning Democratic effort in the 
2010 Election.