{% include "breadcrumbs" %}
{% form_for donation autocomplete:off %}
{% error_messages_for donation %}
{% if page.donation.has_merchant_account? == false %}
No bank account: This page will not work until you add a bank account
{% elsif page.donation.merchant_account.is_test_mode? %}
Testing mode: Transactions will not be processed. Use your regular credit card to test, you will not actually be charged.
{% endif %}
  • Amount 1
  • Your Info 2
  • Payment 3

{% if request.current_order %} {% for item in request.current_order.items %} {% 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 %} {% endfor %} Clear order {% elsif page.donation.donation_frequency == "monthly" %} {% if page.donation.amount_in_cents != 0 %}

{{ page.donation.amount_formatted }}

Your credit card will be billed automatically every month {% else %}
{{ page.donation.form_amount_options }}
Your credit card will be billed automatically every month {% endif %} {% else %} {% if page.donation.amount_in_cents != 0 %}

{{ page.donation.amount_formatted }}

{% else %}
{{ page.donation.form_amount_options }}
{% endif %} {% if page.donation.max_installments > 1 %} I want to pay this in {% collection_select "num_installments", page.donation.installment_collection, class:"select" %} installments {% endif %} {% endif %}
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{% text_field "first_name", class:"text" %}


{% text_field "last_name", class:"text" %}


{% collection_select "billing_address.country_code", page.donation.countries, "code", "name", class:"select" %}


{% text_field "billing_address.address1", class:"text" %}
{% text_field "billing_address.address2", class:"text" %}
{% text_field "billing_address.address3", class:"text not_us_or_canada" %}


{% text_field "billing_address.city", class:"text" %}


{% text_field "billing_address.state", class:"text" %}


{% collection_select "billing_address.state", page.donation.us_states, "code", "name", class:"select" %}


{% text_field "billing_address.zip", class:"text" %}


{% email_field "email", class:"text" %}


{% text_field "billing_address.phone_number", class:"text" %}

{% check_box "email_opt_in" %} Send me email updates
{% if page.donation.merchant_account.is_employer_and_occupation_required? %}


{% text_field "employer", class:"text" %}


{% text_field "occupation", class:"text" %}

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


{% collection_select "work_address.country_code", page.donation.countries, "code", "name", class:"select" %}


{% text_field "work_address.address1", class:"text" %}
{% text_field "work_address.address2", class:"text" %}
{% text_field "work_address.address3", class:"text work_not_us_or_canada" %}


{% text_field "work_address.city", class:"text" %}


{% text_field "work_address.state", class:"text" %}


{% text_field "work_address.zip", class:"text" %}

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


{% collection_select "work_address.country_code", page.donation.countries, "code", "name", class:"select" %}


{% text_field "work_address.city", class:"text" %}


{% text_field "work_address.state", class:"text" %}


{% text_field "work_address.zip", class:"text" %}

{% 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.merchant_account.is_corporate_contribution_required? %}

{% endif %} {% if page.donation.merchant_account.is_taxable? %}

Contributions are not tax deductible.

{% else %}

Contributions are tax deductible.

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

{% if custom_field.is_text? or custom_field.is_number? %} {% text_field custom_field_id, class:"text" %} {% elsif custom_field.is_boolean? %} {% elsif custom_field.is_multiple_choice? %} {% collection_select custom_field_id, custom_fields.donation[custom_field.slug].multiple_choice_options, class:"select" %} {% endif %}

Continue Back
{% if page.donation.has_merchant_account? and page.donation.merchant_account.is_paypal_express? == false %}


{% text_field "card_number", class:"text" %}

{{ page.donation.merchant_account.accepted_card_icons }}


{{ page.donation.form_card_expires_on }}


{% text_field "card_verification", class:"text" %}

{% endif %} {% if page.donation.merchant_account.has_contribution_rules? %}


{{ page.donation.merchant_account.contribution_rules }}

{% endif %} {% if page.donation.merchant_account.is_de? %}

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

{% endif %}
{% if page.donation.has_merchant_account? and page.donation.merchant_account.is_paypal_express? %}
{% submit_tag "Continue to Paypal", class:"success-button" %}
{{ page.donation.merchant_account.accepted_card_icons }}
{% else %} {% submit_tag "Process Donation", class:"success-button" %} {% endif %}
Back
{% endform_for %}
{% if page.headline.size > 0 %}

{{ page.headline }}

{% endif %} {% if page.donation.content.size > 0 %}
{{ page.donation.content }}
{% endif %} {% if page.show_social_slider? and page.public_activities_count > 0 %} {% include "social_slider" %} {% endif %} {% if page.donation.show_recent_donor? %} {% if page.most_recent_donation %}
Who's donating: {{ page.most_recent_donation.signup.published_name_linked }} from {{ page.most_recent_donation.signup.address.location }} donated. Thank you!
{% endif %} {% endif %} {% assign thermo_width = 200 %} {% if page.donation.has_amount_goal? %}
{% if page.donations_count < 1 %} JUST STARTED {% else %} {{ page.donations_amount_format }} raised {% endif %}
GOAL: {{ page.donation.amount_goal_format }}
{% elsif page.donation.has_donor_goal? %}
{% if page.donations_count < 2 %} JUST STARTED {% else %} {{ page.donations_count }} donors {% endif %}
GOAL: {{ page.donation.donor_goal }} DONORS
{% endif %}
{% if page.tags_count > 0 %}
{% include "page_tags" with page %}
{% endif %} {% if page.show_stream? %} {% include "page_stream" %} {% endif %}