Donation
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50
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1,000
Other Amount
Donation Amount
$
Donation Type
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Donation
Gift in Kind
Type
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State
Federal
Council
Candidate
General
Subtype
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General
Political
Your Info
First Name
*
Last Name
*
Donor Type
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Individual
Business
Trust
Unincorporated Association
Business Name
*
ABN
Landline (optional)
Mobile Number
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Email
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Address
Street
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Suburb
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Post Code
*
State
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Country
*
Hidden Donor's Info (Contribution)
Donor's Email
Donor's First Name
Donor's Last Name
Donor Declaration
I am NOT a prohibited donor
*
This donation is made with the intention that it is used for a State Electoral Purpose
*
Anonymous donors, foreign residents and property developers, their related bodies corporate and close associates (including directors and spouses of directors) and property development industry representative organisations are prohibited donors further to the Local Government Electoral (Implementing Stage 1 of Belcarra) and Other Legislation Amendment Act 2018.
Payment Type
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Single
Recurring
It seems you already have an active recurring payment, please use the
Single Payment
option instead.
Card Details - Single Payment
Amount
$
0.00
Shipping
$
0
Taxes
$
0
Subtotal
$
0.00
Initial Fee
$
0
Total Amount
$
0
Credit Card
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CVV
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Expiry
*
--MM--
--YYYY--
Card Details - Recurring Payment
Amount
$
0.00
Shipping
$
0
Taxes
$
0
Subtotal
$
0.00
Initial Fee
$
0
Total Amount
$
0.00
Credit Card
*
CVV
*
Expiry
*
--MM--
--YYYY--
Stripe Charge Id
Stripe Plan Id
Active Recurring Payment?
Low Value Donor Form Submitted
Active Recurring Payment?