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Contribute

Yes, I agree. Enough is enough! I will support the 2012 Automobile Insurance Discount Act with my contribution 
of:</strong></p>
                         <p>The suggested contribution is $3 per auto policy-in-force.

(The suggested contribution is $3 per auto policy-in-force.)

$15,000 $10,000 $5,000 $2,500 $1,000 $500 $250 Other

State law requires that we have the information below before we may accept your contribution. Personal, business and corporate checks and credit cards are acceptable. There are no limits on the amount of your contribution. Contributions are not tax deductible as charitable contributions for income tax purposes.

Donor Information


 (If self-employed, name of company)

 (xxx-xxx-xxxx)

Billing Information

If paying by credit card the following information is required:

Payment in full


 (numbers only)
 

Paid for by the 2012 Auto Insurance Discount Act, sponsored by the American Agents Alliance with support from California Insurance Providers for Competitive Prices and Consumer Discounts, major funding by George Joseph. Committee ID: 1340976.