Friends of Fred Thompson

P. O. Box 128349  Nashville, TN 37212-8349

Contributor Information Form: All Contributors Please Complete

Contributions to Friends of Fred Thompson are not tax deductible for federal income tax purposes.

Contributions to Friends of Fred Thompson will be used in connection with federal elections and are subject
to the limits and prohibitions of federal law. The maximum an individual may contribute is $2,300 ($4,600
per couple). Joint contributions require the signatures of both spouses. Corporate and foreign national
contributions are not permitted under federal law.

Federal law requires us to use our best efforts to obtain and report the name, mailing address, occupation
and name of employer for each individual whose contributions aggregate in excess of $200 in an election
cycle.

____________________________________________________________________________________________________________
Full name Spouse Name
____________________________________________________________________________________________________________
Address
____________________________________________________________________________________________________________
City State Zip
____________________________________________________________________________________________________________
Home Phone Office Phone
____________________________________________________________________________________________________________
Fax E-Mail
____________________________________________________________________________________________________________
Employer Occupation
____________________________________________________________________________________________________________
Spouse’s Employer Spouse’s Occupation

Check Contributions
The contribution to Friends of Fred Thompson drawn on check # _______________ of the account named
as ___________________________________________________________ , represents personal funds
and is not drawn on an account maintained by an incorporated entity.
_______________________________________ _____________________________________________
Signature of Original Contributor Signature of Spouse (if joint contribution)

Please make check payable to:

Friends of Fred Thompson

Paid for by Friends of Fred Thompson