Visa K MasterCard K AMEX K Discover Account Number Expiration Date Name on Card Signature Mail to: Romney Victory, Inc. do Fifi Knott •190 Elizabeth Street, #6R •New York, NY, 10012 ■ USPS Mail Only Or Fax: 212-298-8339; or Scan/Email to: Or Contribute Online: Fundraiser ID: Source (or Event) Code: