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

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

{% endif %} {% assign thermo_width = 100 %} {% if page.donation_v2.has_amount_goal? %}

{% if page.donations_count < 1 %}

{% else %}

{{ page.donations_amount_format }} raised

{% endif %}

GOAL: {{ page.donation_v2.amount_goal_format }}

{% elsif page.donation_v2.has_donor_goal? %}

{% if page.donations_count < 2 %}

{% else %}

{{ page.donations_count }} donors

{% endif %}

{{ page.donation_v2.donor_goal }} 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 your regular credit card to test, you will not actually be charged.

{% endif %}

Amount 1
Your Info 2
Payment 3

{% if request.current_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 %}

{% 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 %}

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

Paid monthly

{% endif %}

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

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

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

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

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

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

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

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

{% unless page.show_consent_form? %}

{% check_box "email_opt_in" %} Send email updates

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

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

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

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

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

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

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

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

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

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

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

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

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

{% 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:"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:"text" %} {% elsif custom_field.is_number? %} {{ custom_field.name }} {% number_field custom_field_id, class:"text" %} {% elsif custom_field.is_boolean? %}

{% check_box custom_field_id, class:"checkbox" %} {{ custom_field.name }}

{% elsif custom_field.is_multiple_choice? %}

{{ custom_field.name }} {% collection_select custom_field_id, custom_fields.donation[custom_field.slug].multiple_choice_options, class:"select form-control" %}

{% endif %}

{% endfor %} {% if page.donation_v2.merchant_account.is_taxable? %}

Contributions are not tax deductible.

{% else %}

Contributions are tax deductible.

{% endif %}

Back

Credit Card

{% payment_field 'card' %}

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

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

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

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

{% endif %}

{% if request.current_order %} {{page.donation_v2.ticket_purchase_total}} {% else %} {% if page.donation_v2.confirmation_amount %} {{ page.donation_v2.currency_symbol }}{{ page.donation_v2.confirmation_amount }} {% else %} Please select an amount {% endif %} {% if page.donation_v2.donation_frequency == "one-time" %} {% elsif page.donation_v2.donation_frequency == "monthly" %}

paid monthly

{% else %}

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

{% endif %} {% endif %}

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

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

Back

{% endform_for %}

{{ page.headline }}

{{ page.donation_v2.amount_formatted }}