Cashier'S Check Or Money Order Form For Multiple Donors
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1Cashier’s Check or Money Order Form for Multiple Donors
From Austin to Washington…Working for the future of the Texas community banking industry.
The IBAT PAC is the only state PAC
The IBAT FedPAC was created to give
exclusively committed to representing
community bankers a voice not only in
community banks.
Austin, but in Washington, too!
In compliance with election laws, if your company prefers to send one cashier’s check or money order for a combined
State or Federal PAC contribution from directors, officers and/or employees, we must have either: 1) a standard
contribution form from each contributor or 2) this form with names and signatures accompanying the cashier’s check or
money order.
I want to do my part!
By my signature below, I hereby acknowledge that I have made a personal contribution through a cashier’s check or
money order issued to the IBAT PAC or IBAT FedPAC.
CONTACT INFORMATION
NAME
DATE
COMPANY NAME
MAILING ADDRESS
CITY / STATE / ZIP
DONOR INFORMATION
(make additional copies as necessary)
PRINTED NAME
SIGNATURE
OCCUPATION
IBAT PAC Amount $______
IBAT FedPAC Amount $______
PRINTED NAME
SIGNATURE
OCCUPATION
IBAT PAC Amount $______
IBAT FedPAC Amount $______
PRINTED NAME
SIGNATURE
OCCUPATION
IBAT PAC Amount $______
IBAT FedPAC Amount $______
PRINTED NAME
SIGNATURE
OCCUPATION
IBAT PAC Amount $______
IBAT FedPAC Amount $______
PRINTED NAME
SIGNATURE
OCCUPATION
IBAT PAC Amount $______
IBAT FedPAC Amount $______
Please send separate cashier’s checks or money orders for the
TOTAL IBAT PAC $______
TOTAL IBAT FedPAC $______
IBAT PAC total and the IBAT FedPAC total.
IBAT PAC and IBAT FedPAC contributions are not deductible as charitable contributions for federal income tax purposes.
All contributions to the IBAT PAC and IBAT FedPAC are voluntary. You may refuse to contribute without reprisal. Federal
law requires political committees to report the name, mailing address, occupation and name of employer for each
individual whose contributions aggregate in excess of $200 in a calendar year. State election regulations require political
committees to report the name, mailing address, occupation and name of employer for each individual whose
contributions aggregate in excess of $50 in a calendar year.
Return form to: Mae Beth Palone, IBAT, 1700 Rio Grande Street, Suite 100, Austin, TX 78701
03.28.2016
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