Lembo for CT

Contact Information
Employer Information

This information is required by law.

If you are self-employed, please list the name of the entity that is on your paycheck. Please list your line of work. "Business Person" is not acceptable, please enter the type of business instead.

We respectfully request that Partners of Partnerships and Members of LLC's contribute individually, instead of through their respective business entity.

Contribution Information
Payment Information
Confirm Eligibility
  I confirm that the following statements are true and accurate:

By clicking "CONTRIBUTE" below, I hereby certify that all of the information disclosed by me on this contributor form is true and accurate to the best of my knowledge and belief. 
  • I certify that I am NOT a principal of a state contractor or prospective state contractor.  Definition of terms.
  • I certify that I am either a United States citizen or a foreign national with permanent resident status in the United States.
  • I certify that this contribution is made on my personal debit or credit card for which I have a legal obligation to pay and intend to pay from my own personal funds, is not being reimbursed in any manner, is not being made as a loan, is not an otherwise prohibited contribution, and that payment on this card is not made from the funds of a corporation, labor organization, or any other entity.
  • I certify that the address used in this contribution is my residential address and is the billing address associated with this card. 
  • I certify that the name used in this contribution is the name that appears on the credit card used for this contribution.
  • I certify that I am at least 18 years old.
  • Contributions or gifts are not tax deductible.
If you certify the above information, please be sure to check the box at the top of this page before clicking 'contribute.' - Served by NSV11OBWAPI1201