CINXE.COM

GFTG Donation Form

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id="JWTContainer" value="" /><input type="hidden" id="cardinalOrderNumber" value="" /><input type="hidden" id="jsExecutionTracker" name="jsExecutionTracker" value="build-date-1732030303674" /><input type="hidden" id="submitSource" name="submitSource" value="unknown" /><input type="hidden" id="buildDate" name="buildDate" value="1732030303674" /><input type="hidden" name="uploadServerUrl" value="https://upload.jotform.com/upload" /> <div id="formCoverLogo" style="margin-bottom:32px" class="form-cover-wrapper form-has-cover form-page-cover-image-align-center"> <div class="form-page-cover-image-wrapper" style="max-width:752px"><img src="https://www.jotform.com/uploads/tlquinton/form_files/gftg%20logo%20.609e9a3627ca14.52014298.png" class="form-page-cover-image" width="150" height="94" aria-label="Form Logo" style="aspect-ratio:150/94" /></div> </div> <div role="main" class="form-all"> <ul class="form-section page-section"> <li id="cid_26" class="form-input-wide" data-type="control_head"> <div class="form-header-group header-large"> <div class="header-text httac htvam"> <h1 id="header_26" class="form-header" data-component="header">General Donation Form</h1> </div> </div> </li> <li id="cid_30" class="form-input-wide" data-type="control_head"> <div class="form-header-group header-small"> <div class="header-text httal htvam"> <h3 id="header_30" class="form-header" data-component="header">Contact Information</h3> </div> </div> </li> <li class="form-line jf-required" data-type="control_fullname" id="id_31"><label class="form-label form-label-top form-label-auto" id="label_31" for="first_31" aria-hidden="false"> Name<span class="form-required">*</span> </label> <div id="cid_31" class="form-input-wide jf-required" data-layout="full"> <div data-wrapper-react="true"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_31" name="q31_name31[first]" class="form-textbox validate[required]" data-defaultvalue="" autoComplete="section-input_31 given-name" size="10" data-component="first" aria-labelledby="label_31 sublabel_31_first" required="" value="" /><label class="form-sub-label" for="first_31" id="sublabel_31_first" style="min-height:13px">First Name</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="last"><input type="text" id="last_31" name="q31_name31[last]" class="form-textbox validate[required]" data-defaultvalue="" autoComplete="section-input_31 family-name" size="15" data-component="last" aria-labelledby="label_31 sublabel_31_last" required="" value="" /><label class="form-sub-label" for="last_31" id="sublabel_31_last" style="min-height:13px">Last Name</label></span></div> </div> </li> <li class="form-line" data-type="control_textbox" id="id_42"><label class="form-label form-label-top form-label-auto" id="label_42" for="input_42" aria-hidden="false"> Company Name (optional) </label> <div id="cid_42" class="form-input-wide" data-layout="half"> <input type="text" id="input_42" name="q42_companyName" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_42" value="" /> </div> </li> <li class="form-line form-line-column form-col-1 jf-required" data-type="control_email" id="id_33"><label class="form-label form-label-top" id="label_33" for="input_33" aria-hidden="false"> Email<span class="form-required">*</span> </label> <div id="cid_33" class="form-input-wide jf-required" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="email" id="input_33" name="q33_email" class="form-textbox validate[required, Email]" data-defaultvalue="" autoComplete="section-input_33 email" style="width:310px" size="310" data-component="email" aria-labelledby="label_33 sublabel_input_33" required="" value="" /><label class="form-sub-label" for="input_33" id="sublabel_input_33" style="min-height:13px">example@example.com</label></span> </div> </li> <li class="form-line form-line-column form-col-2" data-type="control_phone" id="id_32"><label class="form-label form-label-top" id="label_32" for="input_32_full"> Phone Number </label> <div id="cid_32" class="form-input-wide" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="tel" id="input_32_full" name="q32_phoneNumber32[full]" data-type="mask-number" class="mask-phone-number form-textbox validate[Fill Mask]" data-defaultvalue="" autoComplete="section-input_32 tel-national" style="width:310px" data-masked="true" placeholder="(000) 000-0000" data-component="phone" aria-labelledby="label_32" value="" /></span> </div> </li> <li class="form-line jf-required" data-type="control_address" id="id_34"><label class="form-label form-label-top form-label-auto" id="label_34" for="input_34_addr_line1" aria-hidden="false"> Billing Address<span class="form-required">*</span> </label> <div id="cid_34" class="form-input-wide jf-required" data-layout="full"> <div summary="" class="form-address-table jsTest-addressField"> <div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_34_addr_line1" name="q34_address34[addr_line1]" class="form-textbox validate[required] form-address-line" data-defaultvalue="" autoComplete="section-input_34 address-line1" data-component="address_line_1" aria-labelledby="label_34 sublabel_34_addr_line1" required="" value="" /><label class="form-sub-label" for="input_34_addr_line1" id="sublabel_34_addr_line1" style="min-height:13px">Street Address</label></span></span></div> <div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_34_addr_line2" name="q34_address34[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autoComplete="section-input_34 address-line2" data-component="address_line_2" aria-labelledby="label_34 sublabel_34_addr_line2" value="" /><label class="form-sub-label" for="input_34_addr_line2" id="sublabel_34_addr_line2" style="min-height:13px">Street Address Line 2</label></span></span></div> <div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-city-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_34_city" name="q34_address34[city]" class="form-textbox validate[required] form-address-city" data-defaultvalue="" autoComplete="section-input_34 address-level2" data-component="city" aria-labelledby="label_34 sublabel_34_city" required="" value="" /><label class="form-sub-label" for="input_34_city" id="sublabel_34_city" style="min-height:13px">City</label></span></span><span class="form-address-line form-address-state-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_34_state" name="q34_address34[state]" class="form-textbox validate[required] form-address-state" data-defaultvalue="" autoComplete="section-input_34 address-level1" data-component="state" aria-labelledby="label_34 sublabel_34_state" required="" value="" /><label class="form-sub-label" for="input_34_state" id="sublabel_34_state" style="min-height:13px">State / Province</label></span></span></div> <div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-zip-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_34_postal" name="q34_address34[postal]" class="form-textbox validate[required] form-address-postal" data-defaultvalue="" autoComplete="section-input_34 postal-code" data-component="zip" aria-labelledby="label_34 sublabel_34_postal" required="" value="" /><label class="form-sub-label" for="input_34_postal" id="sublabel_34_postal" style="min-height:13px">Postal / Zip Code</label></span></span></div> </div> </div> </li> <li id="cid_35" class="form-input-wide" data-type="control_head"> <div class="form-header-group header-default"> <div class="header-text httal htvam"> <h2 id="header_35" class="form-header" data-component="header">Select Donation Level</h2> </div> </div> </li> <li class="form-line" data-type="control_checkbox" id="id_43"><label class="form-label form-label-top form-label-auto" id="label_43" aria-hidden="false"> Amount (Select one or enter OTHER donation amount </label> <div id="cid_43" class="form-input-wide" data-layout="full"> <div class="form-single-column" role="group" aria-labelledby="label_43" data-component="checkbox"><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_43" type="checkbox" class="form-checkbox" id="input_43_0" name="q43_amountselect[]" data-calcvalue="10000" value="Partner - $2,500" /><label id="label_input_43_0" for="input_43_0">Partner - $2,500</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_43" type="checkbox" class="form-checkbox" id="input_43_1" name="q43_amountselect[]" data-calcvalue="5000" value="Champion - $1,000" /><label id="label_input_43_1" for="input_43_1">Champion - $1,000</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_43" type="checkbox" class="form-checkbox" id="input_43_2" name="q43_amountselect[]" value="Advocate - $500" /><label id="label_input_43_2" for="input_43_2">Advocate - $500</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_43" type="checkbox" class="form-checkbox" id="input_43_3" name="q43_amountselect[]" data-calcvalue="3000" value="Supporter - $250" /><label id="label_input_43_3" for="input_43_3">Supporter - $250</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_43" type="checkbox" class="form-checkbox" id="input_43_4" name="q43_amountselect[]" data-calcvalue="15000" value="Friend - $100" /><label id="label_input_43_4" for="input_43_4">Friend - $100</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_43" type="checkbox" class="form-checkbox" id="input_43_5" name="q43_amountselect[]" value="Contributor - $50.00" /><label id="label_input_43_5" for="input_43_5">Contributor - $50.00</label></span></div> </div> </li> <li class="form-line" data-type="control_radio" id="id_48"><label class="form-label form-label-top form-label-auto" id="label_48" aria-hidden="false"> Is this donation is for the "Colonel Frank 'Stub' Chace and Joy Dean Chace Scholarship Fund </label> <div id="cid_48" class="form-input-wide" data-layout="full"> <div class="form-single-column" role="group" aria-labelledby="label_48" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_48" type="radio" class="form-radio" id="input_48_0" name="q48_isThis" value="Yes" /><label id="label_input_48_0" for="input_48_0">Yes</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_48" type="radio" class="form-radio" id="input_48_1" name="q48_isThis" value="No" /><label id="label_input_48_1" for="input_48_1">No</label></span></div> </div> </li> <li class="form-line" data-type="control_textbox" id="id_47"><label class="form-label form-label-top form-label-auto" id="label_47" for="input_47" aria-hidden="false"> Other Donation Amount </label> <div id="cid_47" class="form-input-wide" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_47" name="q47_typeA47" data-type="input-textbox" class="form-textbox validate[Numeric]" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_47 sublabel_input_47" value="" /><label class="form-sub-label" for="input_47" id="sublabel_input_47" style="min-height:13px">Enter amount</label></span> </div> </li> <li class="form-line always-hidden" data-type="control_calculation" id="id_46"><label class="form-label form-label-top form-label-auto" id="label_46" for="input_46" aria-hidden="false"> TOTAL DONATION AMOUNT </label> <div id="cid_46" class="form-input-wide always-hidden" data-layout="half"> <input aria-labelledby="label_46" data-component="calculation" type="text" data-defaultvalue="0" class="form-textbox" data-type="input-textbox" id="input_46" name="q46_totalDonation" size="20" value="0" /> </div> </li> <li class="form-line" data-type="control_radio" id="id_51"><label class="form-label form-label-top form-label-auto" id="label_51" aria-hidden="false"> Would you like this to be a recurring donation? </label> <div id="cid_51" class="form-input-wide" data-layout="full"> <div class="form-single-column" role="group" aria-labelledby="label_51" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_51" type="radio" class="form-radio" id="input_51_0" name="q51_wouldYou" value="No, this is a one-time donation" /><label id="label_input_51_0" for="input_51_0">No, this is a one-time donation</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_51" type="radio" class="form-radio" id="input_51_1" name="q51_wouldYou" value="Yes, I will donate this amount monthly" /><label id="label_input_51_1" for="input_51_1">Yes, I will donate this amount monthly</label></span></div> </div> </li> <li class="form-line card-1col" data-type="control_stripe" id="id_41" data-payment="true"><label class="form-label form-label-top" id="label_41" for="input_41" aria-hidden="false"> Donation Amount </label> <div id="cid_41" class="form-input-wide" data-layout="full"> <div data-wrapper-react="true" class="stripe-payment-wrapper" data-stripe-currency="USD"> <div data-wrapper-react="true" class="product-container-wrapper"> <div class="filter-container"></div><input type="hidden" name="simple_fpc" data-payment_type="stripe" data-component="payment1" value="41" /><input type="hidden" name="payment_transaction_uuid" id="paymentTransactionId" /><input type="hidden" name="payment_version" id="payment_version" value="4" /><input type="hidden" name="payment_total_checksum" id="payment_total_checksum" data-component="payment2" /><input type="hidden" name="payment_discount_value" id="payment_discount_value" data-component="payment3" /> <div id="image-overlay" class="overlay-content" style="display:none"><img id="current-image" /><span class="lb-prev-button">prev</span><span class="lb-next-button">next</span><span class="lb-close-button">( X )</span><span class="image-overlay-product-container"></span></div><span class="form-sub-label-container" style="vertical-align:top"><input type="text" class="form-textbox validate[Numeric]" id="input_41_donation" name="q41_donationAmount[price]" data-component="paymentDonation" aria-labelledby="label_41" data-testid="donationInput" value="" /><span class="donation_currency">USD</span><label data-testid="donationSubLabel" class="form-sub-label" for="input_41_donation" style="min-height:13px">Donation</label></span> <hr /> </div> <div id="stripe-templates"> <div class="stripe-sca-template"> <div> <table class="payment-up-form-table" style="border:0;margin-bottom:10px" cellPadding="0" cellSpacing="0"> <tbody> <tr> <td width="50%"></td> </tr> </tbody> </table> <table class="form-address-table payment-form-table" style="border:0" cellPadding="0" cellSpacing="0"> <tbody> <tr> <th colSpan="2" style="text-align:left" id="ccTitle41">Payment Details</th> </tr> <tr> <td width="50%"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_41_cc_firstName" name="q41_donationAmount[cc_firstName]" class="form-textbox cc_firstName" data-defaultvalue="" size="20" placeholder="First Name" data-component="cc_firstName" aria-label="Credit Card First Name" aria-labelledby="" value="" /><label class="form-sub-label" for="input_41_cc_firstName" id="sublabel_cc_firstName" style="display:none">First Name</label></span></td> <td width="50%"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_41_cc_lastName" name="q41_donationAmount[cc_lastName]" class="form-textbox cc_lastName" data-defaultvalue="" size="20" placeholder="Last Name" data-component="cc_lastName" aria-label="Credit Card Last Name" aria-labelledby="" value="" /><label class="form-sub-label" for="input_41_cc_lastName" id="sublabel_cc_lastName" style="display:none">Last Name</label></span></td> </tr> <tr class="if_cc_field"> <td width="50%"><span class="form-sub-label-container" style="vertical-align:top"> <div class="form-textbox cc_numberMount "></div><label class="form-sub-label" for="input_41_cc_number" id="sublabel_cc_number" style="display:none">Credit Card Number</label> </span></td> <td width="50%"><span class="form-sub-label-container" style="vertical-align:top"> <div class="form-textbox cc_ccvMount "></div><label class="form-sub-label" for="input_41_cc_ccv" id="sublabel_cc_ccv" style="display:none">Security Code</label> </span></td> </tr> <tr> <td width="50%"><span class="form-sub-label-container" style="vertical-align:top"> <div class="form-textbox cc_cardExpiryMount "></div><label class="form-sub-label" for="input_41_cc_card_expiry" id="sublabel_cc_card_expiry" style="display:none">Card Expiration</label> </span></td> <td width="50%"> <tr style="display:none"> <td><input id="stripesca_dummy" style="display:none" /></td> </tr> </td> </tr> </tbody> </table> <div id="payment-element" class="payment-element" style="border:0;display:none"></div><input id="stripePe_dummy" style="display:none" /> </div> </div> </div> </div> </div> </li> <li class="form-line" data-type="control_text" id="id_44"> <div id="cid_44" class="form-input-wide" data-layout="full"> <div id="text_44" class="form-html" data-component="text" tabindex="0"> <p><span style="font-size: 14pt;">Thank you for your support in of the Go for the Greens Foundation!</span></p> </div> </div> </li> <li class="form-line" data-type="control_button" id="id_25"> <div id="cid_25" class="form-input-wide" data-layout="full"> <div data-align="center" class="form-buttons-wrapper form-buttons-center jsTest-button-wrapperField"><button id="input_25" type="submit" class="form-submit-button submit-button jf-form-buttons jsTest-submitField legacy-submit" data-component="button" data-content="">Submit</button></div> </div> </li> <li style="display:none">Should be Empty: <input type="text" name="website" value="" type="hidden" /></li> </ul> </div> <script> JotForm.showJotFormPowered = "new_footer"; </script> <script> JotForm.poweredByText = "Powered by Jotform"; </script><input type="hidden" class="simple_spc" id="simple_spc" name="simple_spc" value="242984662642163" /> <script type="text/javascript"> var all_spc = document.querySelectorAll("form[id='242984662642163'] .si" + "mple" + "_spc"); for (var i = 0; i < all_spc.length; i++) { all_spc[i].value = "242984662642163-242984662642163"; } </script> </form></body> </html><script type="text/javascript">JotForm.isNewSACL=true;</script>