Print and Mail this Form.

YES, I want to fund candidates who support issues important to small business franchisees. I understand that my contribution is not tax deductible and that a corporate check cannot be accepted.

Name                  (as it appears on your charge account):
Home Address:  
City/State/Zip:   
Telephone:        
Email:               

Here is my PAC contribution of:
$100     $200   $300   $500   Other    

Personal Check enclosed (payable to AFA PAC)

Federal election laws require a report of the name, mailing address, occupation and employer for each individual who contributes more than $200 in any calendar year.

Please check here if self-employed.   
Occupation or Title:
Employer or Firm: