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Gustavo Rivera
Candidate for New York State Senate
And
Name/Organization:_______________________________________________________________________
Address: _________________________________________________________________________________
City: __________________________________________ State: ___________Zip:______________________
Home /Cell Phone: _____________________________ Work Phone: ______________________________
Occupation: _____________________________ Employer: _______________________________________
Email: ____________________________________________________Fax:____________________________
To Contribute by Check:
Please make checks payable to “Gustavo Rivera for State Senate” and mail to:
Gustavo Rivera for State Senate
220 Lafayette Street, 3rd Floor
New York, NY 10012
To Contribute by Credit Card
Please charge my: Visa MC Discover Amex / In the amount of: $______________
Name as it appears on card: _____________________________________________________
Billing Address (if different than above):__________________________________________
Account Number: ______________________________________________________________
Exp. Date: _________ Card Verification No.: _____ (last 3 digits on back of card; 4 on front of amex)
Individuals and all non-corporate entities may contribute up to $6,000 for the Primary Election and up to $9,500 for the General
Election. Corporations may contribute up to $5,000 per calendar year (subject to NYS aggregate limits for corporate contributions).
Contributions and gifts to Gustavo Rivera for State Senate are not tax deductible.