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RICHARD H.

COLLINS | DALENPAC
DARWIN DEASON | DOUG DEASON

Invite you to a fundraising luncheon with


CHAIRMAN

JASON CHAFFETZ
REPRESENTATING UTAHs 3rd CONGRESSIONAL DISTRICT
COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM

M O N D A Y , O C T O B E R 3, 2016
12:00 PM

The Office of Richard H. Collins


8150 N ORTH C ENTRAL E XPRE SSWAY
S UITE 1900
D ALLAS , T E XAS

Participation Levels
Host $5,400
Co-Host $2,700
Attendee $1,000

To RSVP please contact James Van Lare at The McIntosh Company at


214-520-2194 or James@McIntoshCompany.com
Paid for and authorized by Friends of Jason Chaffetz

Source: Sunlight Foundation's Party Time www.politicalpartytime.org. The Sunlight Foundation collects these invitations from anonymous lobbyist sources.

Suggested Contribution Amounts:

 Host $5,400  Co-Host $2,700  Attendee $1,000


 Unfortunately, I cannot attend the luncheon, but I would like to support Friends of Jason Chaffetz.
Enclosed is my contribution of $______________.
ALL CONTRIBUTORS PLEASE READ AND COMPLETE:
Contributions are not tax deductible for federal purposes. Federal law requires us to report the name,
address, occupation, and name of employer of each contributor whose contributions exceed $200 in an
election cycle. Individuals may contribute a maximum of $5,400--$2,700 for the primary election and $2,700
for the general election. Multi candidate PACs may give a maximum of $10,000-$5,000 for the primary
election and $5,000 for the general election. Contributions from corporations, foreign nationals, and federal
government contractors are prohibited. Not printed at government expense.
__________________________________________________________________________________________________
Full Name
Spouse Name (if joint contribution)
__________________________________________________________________________________________________
ADDRESS
CITY
STATE
ZIP CODE
__________________________________________________________________________________________________
CELL PHONE
OFFICE PHONE
HOME PHONE
__________________________________________________________________________________________________
FAX NUMBER
E-MAIL
__________________________________________________________________________________________________
Employer, Occupation
Spouses Employer, Occupation (if joint contribution)

Please make checks payable to:

Friends of Jason Chaffetz


5310 Harvest Hill Road, Suite 209, Dallas, Texas 75230

Credit Card Contributions: This contribution to Friends of Jason Chaffetz is drawn on my personal credit card,
represents my personal funds, and is not drawn on an account maintained by an incorporated entity.
To make your personal payment by credit card, please complete the following information:

Please charge my:  Visa

 MasterCard American Express  Discover

$_________________________________________________________________________________________________

Amount of Contribution

Cardholder Name (printed)

__________________________________________________________________________________________________

Card Number

Exp. Date

CVC Code

Billing Zip

__________________________________________________________________________________________________

Signature of Contributor

Signature of Second Contributor (if joint contribution)

Replies and credit card contributions may be faxed to 214-520-1397.


For more information or to RSVP, please contact James Van Lare at The McIntosh Company at 214-520-2194
or James@McIntoshCompany.com.
Paid for and authorized by Friends of Jason Chaffetz

Source: Sunlight Foundation's Party Time www.politicalpartytime.org. The Sunlight Foundation collects these invitations from anonymous lobbyist sources.

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