{% if page.headline.size > 0 %}

{% endif %} {% if page.donation_v2.content.size > 0 %} {{ page.donation_v2.content }} {% endif %} {% if page.donation_v2.has_amount_goal? %}

{% include "progress" percent: page.donation_v2.percent_of_amount_goal, count: page.donations_count, amount: page.donations_amount_format, goal: page.donation_v2.amount_goal_format, label: "raised" %}

{% elsif page.donation_v2.has_donor_goal? %}

{% include "progress" percent: page.donation_v2.percent_of_donor_goal, count: page.donors_count, goal: page.donation_v2.donor_goal, label: "donors" %}

{% endif %} {% form_for donation %}

{% error_messages_for donation %}

{% if page.donation_v2.has_merchant_account? == false %}

No payment processor: This page will not work until you add a payment processor

{% elsif page.donation_v2.merchant_account.is_test_mode? %}

Testing mode: Transactions will not be processed. Use testing cards only.

{% endif %}

{% if request.current_order %}

Your order

{% if item.num_time_periods and item.time_period_type %} {{ item.quantity }} {{ item.name }} @ {{ item.amount }} - billed automatically every {{ item.num_time_periods }} {{item.time_period_type }} {% else %} {{ item.quantity }} {{ item.name }} @ {{ item.amount }} {% endif %}

Clear order

{% else %}

Amount

{% if page.donation_v2.amount_in_cents != 0 %}

{% else %}

{% endif %}

{% if page.donation_v2.accepts_variable_amounts? or page.donation_v2.donation_frequency == "any" %}

{% if page.donation_v2.accepts_variable_amounts? %}

{% endif %} {% if page.donation_v2.donation_frequency == "any" %}

{% endif %} {% if page.donation_v2.donation_frequency == "monthly" %}

Paid monthly

{% elsif page.donation_v2.donation_frequency == "annual" %}

Paid annually

{% endif %}

Pay with

{% if page.donation_v2.express_payment_activated? %}

{% endif %}

If you use Apple Pay, your confirmation prompt may refer to our processor, "NationBuilder"

Change payment method

Payment method information has been saved.

Change payment method

{% payment_field 'card' %}

Change payment method

Pay with

Change payment method

You're almost done! Submit your donation below

Your information

Edit

First Name {% text_field "first_name", class:"form-control" %}

Last Name {% text_field "last_name", class:"form-control" %}

Email {% email_field "email", class:"form-control" %}

Phone {% phone_field "billing_address.phone_number", class:"form-control" %}

Edit ,

Country {% select_field "billing_address.country_code", page.donation_v2.countries, "code", "name", class:"form-control" %}

Billing Address {% text_field "billing_address.address1", class:"form-control" %} {% text_field "billing_address.address2", class:"form-control mt-2 text" %} {% text_field "billing_address.address3", class:"form-control mt-2 text not-us-or-canada hide" %}

City {% text_field "billing_address.city", class:"form-control" %}

Postal code {% text_field "billing_address.zip", class:"form-control" %}

{% if page.donation_v2.merchant_account.is_employer_and_occupation_required? %}

Employer {% text_field "employer", class:"form-control", required:"required" %}

Occupation {% text_field "occupation", class:"form-control", required:"required" %}

{% if page.donation_v2.merchant_account.is_employer_address_required? %}

Employer Country {% select_field "work_address.country_code", page.donation_v2.countries, "code", "name", class:"select", required:"required" %}

Employer Address {% text_field "work_address.address1", class:"form-control", required:"required" %} {% text_field "work_address.address2", class:"form-control mt-2" %} {% text_field "work_address.address3", class:"form-control mt-2 work-not-us-or-canada hide" %}

Employer City {% text_field "work_address.city", class:"form-control", required:"required" %}

State {% text_field "work_address.state", class:"form-control", required:"required" %}

Postal code {% text_field "work_address.zip", class:"form-control", required:"required" %}

{% elsif page.donation_v2.merchant_account.is_employer_city_required? %}

Employer Country {% select_field "work_address.country_code", page.donation_v2.countries, "code", "name", class:"select", required:"required" %}

Employer City {% text_field "work_address.city", class:"form-control", required:"required" %}

Postal code {% text_field "work_address.zip", class:"form-control", required:"required" %}

{% endif %}

Law requires we ask for your employer and occupation. If you don't have an employer or are retired, put N/A, and if you are self-employed put "self-employed" in employer and describe your occupation.

{% endif %} {% if page.donation_v2.merchant_account.is_corporate_contribution_required? %}

{% check_box "is_corporate_contribution", class:"custom-control-input checkbox" %} This is a contribution from a business.

{% endif %} {% for cf in custom_fields.donation %} {% assign custom_field = cf[1] %} {% assign custom_field_id = 'custom_values.' | append: custom_field.slug %}

{% if custom_field.is_text? %} {{ custom_field.name }} {% text_field custom_field_id, class:"form-control" %} {% elsif custom_field.is_number? %} {{ custom_field.name }} {% number_field custom_field_id, class:"form-control" %} {% elsif custom_field.is_boolean? %}

{% check_box custom_field_id, class:"custom-control-input checkbox" %} {{ custom_field.name }}

{% elsif custom_field.is_multiple_choice? %} {{ custom_field.name }} {% select_field custom_field_id, custom_fields.donation[custom_field.slug].multiple_choice_options, class:"select" %} {% endif %}

{% endfor %}

{% if page.donation_v2.merchant_account.has_contribution_rules? %} Contribution rules {{ page.donation_v2.merchant_account.contribution_rules }}

{% check_box "is_confirmed", class:"custom-control-input checkbox" %} I confirm that the above statements are true and accurate.

{% endif %} {% unless page.show_consent_form? %}

{% check_box "email_opt_in", class:"custom-control-input" %} Send email updates

{% endunless %} {% if site.ask_to_publish_to_stream? %}

{% check_box "is_private", class:"custom-control-input checkbox" %} Don't publish my donation on the website.

{% endif %}

{% if page.show_consent_form? %} {% include "consent_form" %} {% endif %}

{% if page.donation_v2.merchant_account.is_taxable? %} Contributions are not tax deductible. {% else %} Contributions are tax deductible. {% endif %}

{% if request.current_order %} {{ page.donation_v2.ticket_purchase_total }} {% else %} {% if page.donation_v2.confirmation_amount %}

{% else %}

Total will show here after an amount has been selected

{% endif %} {% if page.donation_v2.donation_frequency == "one-time" %} {% elsif page.donation_v2.donation_frequency == "monthly" %}

paid monthly

{% elsif page.donation_v2.donation_frequency == "annual" %}

paid annually

{% else %}

{% if page.donation_v2.interval_monthly? %}paid monthly{% endif %}

{% endif %} {% endif %}

{% if request.current_order %} {% submit_tag "Process payment", class:"btn btn-primary" %} {% else %} {% submit_tag "Donate now", class:"btn btn-primary" %} {% endif %}

Back

{% endform_for %}

{% if site.has_background_image? %}

{% include "footer" %}

{% endif %}

{{ page.headline }}

Your order