Contribute To Proposition 33

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

If paying by check click here, print and fill out the attached form and send to:

2012 Automobile Insurance Discount Act
1029 J Street, Suite 120
Sacramento, CA 95814
Campaign ID :: 1340976
* Please make check payable to: 2012 Automobile Insurance Discount Act.

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

First Name:

Last Name:

Occupation:

Employer:

(If self-employed, name of company)

Contribution Type:

Address:

City:

State:

Zip:

Phone:

(xxx-xxx-xxxx)

Email Address:

Billing Information

If paying by credit card the following information is required:

Payment in full

Name on Card:

Address:

City:

State:

Zip:

Credit Card Number:

(numbers only)

Credit Card Expiration:

Security Code:

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.