Small Business Pledge Drive

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Stand with Dr. Dean Small Business Pledge Drive

Thanks for taking part in the Stand with Dr. Dean Small Business Pledge Drive. We need to show Senators and Representatives that small businesses in their community support real healthcare reform.

Now, take a moment to tell us which businesses in your area support the public option. Fill out the information below for businesses that pledged their support, including the names of the people you spoke with, their e-mail address, and the names of their businesses.

You can enter up to three businesses below. Found more than three businesses near you to pledge their support? That's great! Just fill out all the information for the first three businesses below and hit "submit." Then you can come back to this page and fill out three more.

Thank you for all that you do,

-Adam, Michael and Kate
DFA Field Team

For more Pledge Drive materials, please visit www.democracyforamerica.com/pledgeFAQ.

First name (Business leader)

Last name

E-mail address

Business name

How did it go?

First name

Last name

E-mail address

Business name

How did it go?

First name

Last name

E-mail address

Business name

How did it go?

* marks required fields

First Name

Last Name

Email Address

Address

City

State

Zip Code

Phone Number

Have questions? Contact the DFA Field Team at field@democracyforamerica.com or give us a call at (802) 651-3200, ext. 127.


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