AmeriCan GOTV Political Campaign Websites
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Please assist our preparation by providing us with the following information and by answering the following questions regarding your background:
Fields marked with an asterisk(*) are required.
*First Name
*Last Name
Organization
Title
*Email Address
*Confirm Email Address

Address 1
Address 2
City
*First Name
State
*Last Name
Zip Code
*Email
*Confirm Email
*Phone
*Phone
Best Time to contact you:
Best time to contact you:
 
 
 
 
 

Campaign Information
 
* Have you now or have you ever had a candidate web site?
 
 
 

Web site addrress is/was
Have you now or have you ever had a candidate web site?
 
 
 
 
Website Address
The Website being considered will promote a candidate for what office

*Candidate Office
Campaign Information
The date of the candidate's election is:
Candidate Name
Primary
The Website being considered will promote a candidate for what office
*General
*The candidate is the
  Incumbent
  Challenger
The date of the candidate’s election is:
Approximately how many registered voters will be eligible to vote in this election?
Primary
Approx.
General
*When does the campaign plan need the web site on-line?
*Where did you hear about us?
The candidate is the:
 
 
Approximately how many registered voters will be eligible to vote in this election:
When does the campaign plan need the web site on-line?
Where did you hear about us?

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1625 Howard Gap Loop Road, Flat Rock, North Carolina, U.S.A. 28731
Toll Free: 866.633.4688 - Telephone: 828.483.4519 - Fax: 888-832-2129