Supporters of Maryland Brewing PAC Contribution Form

Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Organization (if applicable) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

IMPORTANT NOTE: if an individual makes aggregate contributions of $500 or more to a political committee, the individial must provide employer and occupation information to the committee for disclosure on the campaign finance report. Therefore, we ask that everyone who makes a contribution completes this information. Thank you!

Employer {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Occupation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Contribution Amount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Supporters of Maryland Brewing Political Action Committee (SMB-PAC), Brendan O'Leary, Treasurer

{~ Payment_Block_Label}

{binding Group}
{binding Name} - {binding Description}	{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}	{binding displayValue}
{binding Name}:	{binding displayValue}	---

{{ Cognito.resources['payment-amount-due'] + ":" }} {binding displayValue}

Supporters of Maryland Brewing PAC Contribution Form

{{ Cognito.resources['order-number-label'] }}: {binding displayValue}

{{ Cognito.resources['order-date-label'] }}: {binding displayValue}

{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}

{binding BillingName}

{binding BillingAddress.FullInternationalAddress}

{binding PhoneNumber}

{binding EmailAddress}

{binding Group}
{binding Name} - {binding Description}	{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}	{binding displayValue}
{{ Cognito.resources['order-total-label'] }}: {binding displayValue}
{{ Cognito.resources['order-amount-paid'] }}:	({binding displayValue})
{{ Cognito.resources['order-balance-due-label'] }}:	{binding displayValue}

Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Organization (if applicable) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Employer {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Occupation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Contribution Amount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Supporters of Maryland Brewing Political Action Committee (SMB-PAC), Brendan O'Leary, Treasurer

Supporters of Maryland Brewing PAC Contribution Form

{{ Cognito.resources['order-number-label'] }}: {binding displayValue}

{{ Cognito.resources['order-date-label'] }}: {binding displayValue}

{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}

{binding BillingName}

{binding BillingAddress.FullInternationalAddress}

{binding PhoneNumber}

{binding EmailAddress}

{binding Group}
{binding Name} - {binding Description}	{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}	{binding displayValue}
{{ Cognito.resources['order-total-label'] }}: {binding displayValue}
{{ Cognito.resources['order-amount-paid'] }}:	({binding displayValue})
{{ Cognito.resources['order-balance-due-label'] }}:	{binding displayValue}

Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Organization (if applicable) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Employer {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Occupation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Contribution Amount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Supporters of Maryland Brewing Political Action Committee (SMB-PAC), Brendan O'Leary, Treasurer

Supporters of Maryland Brewing PAC Contribution Form

{~ Payment_Block_Label}

Supporters of Maryland Brewing PAC Contribution Form

{{ Cognito.resources['order-transaction-details-header'] }}

{{ Cognito.resources['order-billing-info-header'] }}

Supporters of Maryland Brewing PAC Contribution Form

{{ Cognito.resources['order-transaction-details-header'] }}

{{ Cognito.resources['order-billing-info-header'] }}