This authorization is subject to the terms set forth below: I hereby authorize MSEA-SEIU Local 1989 to charge my credit card for the contribution indicated below, and for said credit card to forward the amount specified to MSEA-SEIU for contribution to SEIU-COPE on a monthly basis. This authorization is voluntarily made based on my specific understanding that:

The authorization of this on-going credit card payment and the making of voluntary contributions are not conditions of my employment by my Employer or membership in the Union, and I understand that I may refuse to contribute without any reprisal;
Only union members and executive/administrative union staff who are U.S. citizens or lawful permanent residents are eligible to contribute to SEIU-COPE;
The amounts in the dropdown box below are merely suggestions, and I understand that I may contribute more or less by some other means without fear of favor or disadvantage from the Union or my Employer;
SEIU-COPE uses the money it receives for political purposes, including but not limited to making contributions and expenditures in connection with federal, state and local elections and addressing political issues of public importance.
Contributions to SEIU-COPE are not deductible for federal income tax purposes.
This authorization is to remain in full force and effect until the credit card listed below has received notification of its termination through the MSEA-SEIU PASER. To CANCEL a PASER Contribution from your credit card please send a letter indicating your desire to do so along with the last four (4) digits of your social security number to MSEA-SEIU Local 1989, 65 State Street, Augusta, ME 04330-5126 ATTN: Shelly Page.
Authorizing your credit card to be charged signifies acceptance of the terms and conditions stated above.

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Effective Date YYYY-MM-DD
Amount of Contribution
OTHER Amount of Contribution
Credit Card Number
Expiration Date YYYY-MM
First Name
Last Name
Credit Card Billing Address
Phone Number
Email Address