Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) STATEMENT OF ELECTRONIC TRANSFER METHOD FORM TRAN 1 ACCOUNT # (Ethics Commission Filers) Please print or type everything other than your signature. 2 NAME OF FILER DESIGNATING TRANSFER METHOD 3 Date Received NAME OF FILER'S COMMITTEE/ CAUCUS (if applicable) 4 OFFICE USE ONLY MAILING ADDRESS ADDRESS APT / SUITE # Date Hand-delivered or Postmarked ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ STATE ○ ○ ○ ○ ○ CITY ZIP CODE Date Processed 5 TELEPHONE NUMBER 6 TRANSFER METHOD ( PHONE NUMBER EXTENSION Date Imaged ) E-MAIL ADDRESS 7 AREA CODE I intend to file my campaign finance reports using the following electronic method of transfer: Over the Internet using Ethics Commission software or third-party vendor software. check this box if you are changing your method of transfer By modem without an Internet connection. By sending or delivering a diskette. Over the Internet using the web filer application on the Ethics Commission's web site. Signature of Filer Date Are you required to file campaign finance reports with the Texas Ethics Commission? Yes www.ethics.state.tx.us No Revised 03/17/2010 American LegalNet, Inc. www.FormsWorkFlow.com