Cryptocurrency Donation

First Name: Last Name: Email: Address: City: State: Zip: Employer: Occupation:

I am retired Phone Number: Donate Now

We are required by NYS Election law to collect and securely store the following information, before sending you off to Coinbase to receive your donation. Please ensure that the name and email address you enter here matches those you enter on Coinbase (apologies for the need to enter these twice). We are required to make our best effort to accurately gather the remaining information. If you have any questions or concerns, please contact us at sharpe@larrysharpe.com