Support the FIADA PAC Fund! Your PAC Contribution helps spread awareness and gain support of issues affecting independent dealers in the state’s capitol.
CONTRIBUTION INFORMATION Contributor’s Name:_________________________________________________________________________ Dealership/Company:________________________________________________________________________ Street Address, City, State, Zip:____________________________________________________________________
q
Check q
q
$500
Credit Card (one time contribution) q q
Credit Card Information:
$250 q
q Visa
$100 q
q
MasterCard
Monthly Credit Card Contribution (until cancel)
$50 q
q
$25
q
American Express
_________ q
Discover
PAYMENT INFORMATION Name on Card: Card number: Exp Date:
Sec. Code:
Billing Phone:
Billing Address Authorized Signature
Make your check payable to FIADA-PAC and mail to: FIADA • 1840 Fidler Court • Tallahassee, FL 32808 If making payment via credit card, you may fax your contribution form to 850.385.3251
www.fiada.com
December 2013 — Independent Dealer — 19