troubleshooting Question

I have a form based upon ASP that uses JavaScript I am trying to get values from the drop down list to populate another field.

Avatar of Jim_OPIMA
Jim_OPIMA asked on
JavaScript
6 Comments1 Solution455 ViewsLast Modified:
I have a client that wants a small change to their website.  They are selling tickets at several different values.  It was based off of a donation page they wanted to reuse.  The challenge I am having is I popped in a field that has number of tickets and the value is based upon level which equated to a price.  The validation was based on a check box being clicked. What is not working is when a ticket is selected the dollar amount is not being passed to the total for the level and the grand total in the bottom right of the form.

I am pasting the entire form here the additions were added in using Dreamweaver MX.

I thank you in advance for helping me on such what I know has to be a simple answer.

I have searched for 4 hours on the forums to no avial.

Thank you.

Jim

<!DOCTYPE html public "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML>
<HEAD>
<TITLE>Donate to the Stroud Water Research Center</TITLE>
<style type="text/css">
BODY {
              background-color: #ffffff;
              color: #000000;
            font-family: Verdana, sans-serif;
      }
A {
        color: #4a601c;
}
P.required {
        color : Red;
}
TD.itopBottomLeft {
        border-left: 1px solid Black;
        border-top: 1px solid Black;
        border-bottom: 1px solid Black;
        background-color: Silver;
}
TD.itopBottom {
        border-top: 1px solid Black;
        border-bottom: 1px solid Black;
        background-color: Silver;
}
TD.itopBottomRight {
        border-right: 1px solid Black;
        border-top: 1px solid Black;
        border-bottom: 1px solid Black;
        background-color: Silver;
}
TD.topLeft {
        border-left: 1px solid Black;
}
TD.topRight {
          border-right: 1px solid Black;
}
TD.topBothSides {
          border-left: 1px solid Black;
          border-right: 1px solid Black;
}
TD.topLeftTop {
          border-left: 1px solid Black;
          border-top: 1px solid Black;
}
TD.topRightTop {
          border-right: 1px solid Black;
          border-top: 1px solid Black;
}
TD.topTop {
          border-top: 1px solid Black;
}
TD.ccTitle {
        color: Black;
        background-color : Silver;
        border : 1px solid Black;
}
TD.ccLeft {
        border-left: 1px solid Black;
}
TD.ccRight {
        border-right: 1px solid Black;
}
TD.checkTitle {
        color: Black;
        background-color : Silver;
        border : 1px solid Black;
}
TD.checkRight {
        border-right: 1px solid Black;
}
TD.checkLeft {
        border-left: 1px solid Black;
}
TD.checkBoth {
        border-left : 1px solid Black;
        border-right: 1px solid Black;
}
TD.checkBottom {
        border-left : 1px solid Black;
        border-right: 1px solid Black;
        border-bottom: 1px solid Black;
}
 </style>
<script language="javascript"><!--
// isNull: checks to see if a variable exists in the form.
function isNull(a) {
   return typeof a == 'undefined';
}
// checkbox: customer can change amounts
function box(itemcheckbox, amountbox) {
calc();      return true;
}
// checkbox: static amounts
function box(itemcheckbox) {
calc();      return true;
}
reValidPrice = /(^\d{1,6}$)|(^\d{1,6}.\d{1,2}$)|(^.\d{1,2}$)/
// checkbox calc()
function calc() {
      var dollars;
      var cents;
      var amount;
      var peiod_loc;
      document.epform.grand_total.value = "0.00";
      for (var i = 0; i < parseInt(document.epform.items_count.value); i++) {
            if ((eval("document.epform.item_price" + i + ".value") != "") && (!(reValidPrice.exec(eval("document.epform.item_price" + i + ".value"))))) {
                        alert("You have entered an invalid price.\nPlease enter only numbers, decimals are optional.");
                        eval("document.epform.item_price"+i+".focus()");
                        eval("document.epform.item_price"+i+".select()");
                        return false;
                }            if ((!(isNaN(parseFloat(eval("document.epform.item_price" + i + ".value")))))
            && (parseFloat(eval("document.epform.item_price" + i + ".value")) != 0.00)
            && (parseFloat(eval("document.epform.item_price" + i + ".value")) != null)) {
                  period_loc = eval("document.epform.item_price"+ i + ".value").toString().indexOf(".")
                  if (period_loc == -1) {
                        dollars = eval("document.epform.item_price" + i + ".value");
                        dollars = Math.abs(parseInt(dollars));
                        cents = ".00";
                  } else {
                        dollars = eval("document.epform.item_price" + i + ".value").substring(0, period_loc);
                        dollars = Math.abs(parseInt(dollars));
                        cents = eval("document.epform.item_price" + i + ".value").substring(period_loc, period_loc+3);
                        if (cents.length == 2) {
                              cents += "0";
                        }
                  }
                  if (isNaN(dollars)) { dollars = "0"; }
                  amount = parseFloat(dollars + cents);
                  eval("document.epform.item_price" + i + ".value = \"" + dollars + cents +"\"");
                        
                  if (eval("document.epform.check_item" + i + ".checked")) {
                        document.epform.grand_total.value = parseFloat(document.epform.grand_total.value) + parseFloat(amount);
                  }
            }
            if (isNaN(parseFloat(eval("document.epform.item_price" + i + ".value")))) {
                  eval("document.epform.item_price" + i + ".value = \"0.00\"");
            }
    }
      if (!(isNull(document.epform.tax_value))) {
            document.epform.grand_total.value = parseFloat(document.epform.grand_total.value) + parseFloat(document.epform.tax_value.value);
      }
      if (!(isNull(document.epform.shipping_value))) {
            if (isNaN(parseFloat(document.epform.shipping_value.value))) {
                        alert("Please enter a valid number in the shipping field\n");
                        document.epform.shipping_value.value ="0.00";
                }
            document.epform.grand_total.value = parseFloat(document.epform.grand_total.value) + parseFloat(document.epform.shipping_value.value);
      }
      period_loc = document.epform.grand_total.value.toString().indexOf(".");
      if (period_loc == '-1') {
            document.epform.grand_total.value += ".00";
            if (!(isNull(document.epform.total))) {
                  document.epform.total.value = document.epform.grand_total.value;
            }
      } else {
            var length = document.epform.grand_total.value.length;
            dollars = document.epform.grand_total.value.substring(0, period_loc);
            dollars = Math.abs(parseInt(dollars));
            cents = document.epform.grand_total.value.substring(period_loc, length);
                switch(cents.length) {
                        case 2:
                                cents += "0";
                                break;
                        case 3:
                                break;
                        default:
                                if (parseInt(cents.substring(3,4)) >= 5) {
                                        last_cent = parseInt(cents.substring(2,3)) + parseInt(1);
                                        cents = cents.substring(0, 2) + last_cent;
                                } else {
                                        cents = cents.substring(0, 3);
                                }
                }
            document.epform.grand_total.value = dollars + cents;
            if (!(isNull(document.epform.total))) {
           document.epform.total.value = document.epform.grand_total.value;
        }
      }                  
      return true;
}
// 10-21-2003 sqadeer  Added code for international phone numbers
// 12-09-2003 sqadeer  Bugfix with missing check/cc fields
//not valid
emailReg1 = /(@.*@)|(\.\.)|(@\.)|(\.@)|(^\.)/
//valid
emailReg2 = /^.+\@(\[?)[a-zA-Z0-9\-\.]+\.([a-zA-Z]{2,6}|[0-9]{1,3})(\]?)$/
//phoneReg = /^(?:[\(][0-9]{3}[\)]|[0-9]{3})[-. ]?[0-9]{3}[-. ]?[0-9]{4}$/
phoneReg = /^\(?(\d{3})\)?\-?[\.\-\/ ]?(\d{3})[\.\-\/ ]?(\d{4})$/
intlphoneReg = /^\d(\d|\-){6,20}/
function check_form() {
  document.epform.Submit.disabled = true;
  var error = 0;
  var error_message = "Errors have occured during the process of your form!\nPlease make the following corrections:\n\n";
  var payment_type = document.epform.payment_type.value;
  var payment_value = null;
  if (document.epform.payment_type.length) {
    for (var i = 0; i < document.epform.payment_type.length; i++)
      if (document.epform.payment_type[i].checked)
        payment_value = document.epform.payment_type[i].value;
  } else if (document.epform.payment_type.checked) {
    payment_value = document.epform.payment_type.value;
  } else if (document.epform.payment_type.value) {
    payment_value = document.epform.payment_type.value;
  }
  var first_name = document.epform.billing_first_name.value;
  var last_name = document.epform.billing_last_name.value;
  var address1 = document.epform.billing_address.value;
  var address2 = document.epform.billing_address2.value;
  var city = document.epform.billing_city.value;
  var state = document.epform.billing_state.value;
  var province = document.epform.billing_province.value;
  var country = document.epform.billing_country.value;
  var zip = document.epform.billing_zip.value;
   
  var email = document.epform.billing_email.value;
   var phone = document.epform.billing_phone.value;
 
  if (!(isNull(document.epform.cnp_security))) { var cnp_security = document.epform.cnp_security.value; }
  if (!(isNull(document.epform.cc_number))) { var cc_number = document.epform.cc_num.value; }
 
  if (!(isNull(document.epform.purchase_order_number))) { var purchase_order_number = document.epform.purchase_order_number.value; }
 
   if (!(isNull(document.epform.ec_rt))) { var ec_rt = document.epform.ec_rt.value; }
  if (!(isNull(document.epform.ec_account))) { var ec_account = document.epform.ec_account.value; }
  if (!(isNull(document.epform.ec_account_type))) { var ec_account_type = document.epform.ec_account_type.value; }
  if (!(isNull(document.epform.ec_id_type))) { var ec_id_type = document.epform.ec_id_type.value; }
  if (!(isNull(document.epform.ec_id_number))) { var ec_id_number = document.epform.ec_id_number.value; }
  if (!(isNull(document.epform.ec_id_state))) { var ec_id_state = document.epform.ec_id_state.value; }
  if (!(isNull(document.epform.ec_bank_name))) { var ec_bank_name = document.epform.ec_bank_name.value; }
  if (!(isNull(document.epform.ec_serial_number))) { var ec_serial_number = document.epform.ec_serial_number.value; }
   var amount = document.epform.grand_total.value;
  if (first_name == "" || last_name == "" || address1 == "" || city  == "" || country == "" || phone == "" || email == "") {
    error_message = error_message + "* Missing required address information.\n";
    error = 1;
  }
  if (state && province)
  {
      error_message += "* Cannot enter both Billing State and Province.\n";
      error = 1;
  }
  if (country == 'US')
  {
    if (!zip)
    {
        error_message += "* Postal Code is required for United States.\n";
        error = 1;
    }
    if (!state)
    {
        error_message += "* Billing State is missing.\n";
      error = 1;
    }
    if (!(phoneReg.exec(phone)) && phone != "")
    {
          error_message = error_message + "* Invalid Phone Number.\n";
          error = 1;
    }
  }
  else
  {
        if (country == 'CA')
        {
                   if (!zip)
            {
                    error_message += "* Postal Code is required for Canada.\n";
                    error = 1;
                }
               if (!province)
               {
                       error_message += "* Billing Province is missing.\n";
                   error = 1;
                }
               if (!(intlphoneReg.exec(phone)) && phone != "")
               {
                     error_message += "* Invalid international phone number (Digits & '-' only, no spaces).\n";
                     error = 1;
               }
       }
 }
  if (!(!emailReg1.exec(email) && emailReg2.test(email)) && email != "") {
      error_message = error_message + "* Invalid E-mail address.\n";
      error = 1;
  }
  if (payment_value == "po") {
              if (purchase_order_number == "") {
                  error_message = error_message + "* Missing Purchase Order number.\n";
                  error = 1;
            }
  }
  if (payment_value == "cc") {
        // cycle through the form elements and trim all fields
        var cc = '';
        var cclen = 0;
        var ccid = 0;
        var myDate = new Date();
        var thisMonth = myDate.getMonth()+1;
        var thisYear = myDate.getFullYear();
        var year = document.epform.year.options[document.epform.year.selectedIndex].value;
        var month = document.epform.month.options[document.epform.month.selectedIndex].value;
        var cclen;
        var ccid;
        month = month.substr(0,2);
        var str = document.epform.cc_type.options[document.epform.cc_type.selectedIndex].value;
        str=str.slice(0,3);
        str=str.toLowerCase();
        if (document.epform.cc_num.value) {
          var cc = document.epform.cc_num.value;
          cc=cc.replace(/[^0-9]/g, "")
          cclen=cc.length;
          ccid=cc.charAt(0);
        }
        else {
          error_message += "* Credit Card Number Is Missing.\n";
          error = 1;
        }
        switch (str) {
          case "vis":
            if (ccid != 4) {
              error_message += "* Credit Card number " + cc + " is not a valid Visa.\n";
              error = 1;
            }
            if (cclen != 16) {
              error_message += "* You have " + cclen + " digits in your Credit Card.  16 digits are required.\n";
              error = 1;
            }
            var cnp_len = 3;
            break;
          case "mas":
            if (ccid != 5) {
              error_message += "* Credit Card number " + cc + " is not a valid MasterCard.\n";
            error = 1;
            }
            if (cclen != 16) {
              error_message += "* You have " + cclen + " digits in your Credit Card.  16 digits are required.\n";
            error = 1;
            }
            var cnp_len = 3;
            break;
          case "dis":
              if (ccid != 6) {
                error_message += "* Credit Card number " + cc + " is not a valid Discover.\n";
              error = 1;
            }
              if (cclen != 16) {
                  error_message += "* You have " + cclen + " digits in your Credit Card.  16 digits are required.\n";
                  error = 1;
              }
              var cnp_len = 4;
               break;
          case "ame":
            if (ccid != 3) {
            error_message += "* Credit Card number " + cc + " is not a valid American Express.\n";
            error = 1;
            }
            if (cclen != 15) {
              error_message += "* You have " + cclen + " digits in your Credit Card.  15 digits are required.\n";
            error = 1;
            }
            var cnp_len = 4;
            break;
          default:
            error_message += "* Please select a Credit Card type.\n";
            error = 1;
            break;
        }
        
        if (year == thisYear) {
          if (month < thisMonth) {
            error_message += "* Expiration Date is invalid.\n";
            error = 1;
          }
        }
        
        }
  if (payment_value == "echeck")
  {
         if (ec_bank_name == "" || ec_serial_number == "" || ec_id_number == "" || ec_id_state == "" || ec_rt == "" || ec_account == "" || ec_account_type == "" || ec_id_type == "") {
           error_message = error_message + "* Missing required fields for check processing.\n";
           error = 1;
          }
         
         if (zip == "")
         {
               error_message = error_message + "* Postal Code is required for check processing.\n";
               error = 1;
         }
  }
  if (amount == "") {
        error_message = error_message + "* Amount is missing.\n";
        error = 1;
  }
  if (error == 1) {
        alert(error_message);
      document.epform.Submit.disabled = false;
        return false;
  } else {
    return true;
  }
}
//-->
</script>
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                                                      </font>
                                                      <P>
                                                      <font face="arial, swiss, helvetica, verdana" size="2">
                                                            <hr size=1>
                              <B>Check the box</B><b> below to reserve your tickets.</b>
                              <FORM name="epform" method="post" action="https://www.merchantamerica.com/swrc/echopay/index.php" onsubmit="return check_form();">
                                                                  <P>
                                                                  <TABLE cellspacing="0" cellpadding="0" width="90%" align="center" border="0">
                                                                        <input type="hidden" name="ba" value="submit">
                                                                        <TR>
                                                                              <TD><font face="arial,helvetica,helv" size=2><input type="hidden" name="items_count" value="8">
                                                                                          <table width="100%" border="0" cellspacing="0" cellpadding="2">
                                                                                                <tr>
                                                                        <td valign=top><font size=2><img src="ag1.jpg" width="117" height="26"></td>
                                                                  </tr>
                                                                                                <tr align="left" bordercolor="#666666">
                                                                                                      <td height="54" valign=top><p><input type="checkbox" name="check_item3" value="1" onclick="return box(check_item3, item3);">
                                                                                                      $60.00 Lecture Only Tickets<br>
                                                                                                      <font face="arial,helvetica,helv" size=2><font face="arial,helvetica,helv" size=2>$<font face="arial,helvetica,helv" size=2>
                                                                                  <input type="text" name="item_price3" value="0.00" size="6" maxlength="10" onBlur="return calc();">
                                                                                </font>Please reserve  this many tickets</font><font face="arial,helvetica,helv" size=2>
                                                                                <select name="select_lecture">
                                                                                  <option value="60.00">1</option>
                                                                                  <option value="120.00">2</option>
                                                                                  <option value="180.00">3</option>
                                                                                  <option value="240.00">4</option>
                                                                                  <option value="300.00">5</option>
                                                                                  <option value="360.00">6</option>
                                                                              </select>  
                                                                                Lecture only tickets at $60.00 each.</font></font></p></td>
                                                                                                      <td valign=top>
                                                                                                  </td>
                                                                                                </tr>
                                                                                                <tr>
                                                                                                      <td valign=top>                                                                                                        <p>
      <input type="checkbox" name="check_item2" value="1" onClick="return box(check_item2, item2);">                                                                      
  $1000.00 Sponsor Tickets<br>
  <em><font size="2" face=&quot;arial,helvetica,helv>A limited number of sponsor tickets are available to the public. These tickets include the lecture, a booksigning by the speaker, cocktails and dinner. These tickets are $1,000 per person with $350 being tax deductible.</font></em><br>
                                                                        $
                                                                        <input type="text" name="item_price2" value="0.00" size="6" maxlength="10" onblur="return calc();">                                                                      
                                                                        <font size="2" face="arial,helvetica,helv">Please reserve this many tickets <font face="arial,helvetica,helv" size=2>
                                                                        <select name="select_sponsor">
                                                                          <option value="1000.00">1</option>
                                                                          <option value="2000.00">2</option>
                                                                          <option value="3000.00">3</option>
                                                                          <option value="4000.00">4</option>
                                                                          <option value="5000.00">5</option>
                                                                          <option value="6000.00">6</option>
                                                                          <option value="7000.00">7</option>
                                                                          <option value="8000.00">8</option>
                                                                          <option value="9000.00">9</option>
                                                                          <option value="10000.00">10</option>
                                                                        </select>
                                                                        </font>Sponsor ticket(s) at $1,000 each</font>.
                                                                        <input type="hidden" name="item1" value="Headwater+Sponsor">                                                                      
                                                                        <BR>                                                                                          
                                                                      </p>
                                                                                                  </td>
                                                                                                      <td valign=top>
                                                                                                  </td>
                                                                                                </tr>
                                                                                                <tr>
                                                                                                      <td valign=top><p>
        <input type="checkbox" name="check_item1" value="1" onclick="return box(check_item1, item1);">
$200.00 Young Sponsor  Tickets<br>
<em><font face="arial,helvetica,helv" size=2>A limited number of young sponsor tickets are available to the public. These tickets include the lecture, a booksigning by the speaker, cocktails and dinner. These tickets are $200 per person.<br>
</font></em><font face="arial,helvetica,helv" size=2>$
                                                                      <input type="text" name="item_price1" value="0.00" size="6" maxlength="10" onblur="return calc();">
                                                                      </font><font face="arial,helvetica,helv" size=2><font face="arial,helvetica,helv" size=2>Please reserve this many tickets <font color="red" face="arial,helvetica,helv" size=2>
                                                                      </font><font face="arial,helvetica,helv" size=2><font color="red" face="arial,helvetica,helv" size=2>
                                                                      <select name="select">
                                                                        <option value="200.00">1</option>
                                                                        <option value="400.00">2</option>
                                                                        <option value="600.00">3</option>
                                                                        <option value="800.00">4</option>
                                                                        <option value="1000.00">5</option>
                                                                        <option value="1200.00">6</option>
                                                                        <option value="1400.00">7</option>
                                                                        <option value="1600.00">8</option>
                                                                        <option value="1800.00">9</option>
                                                                        <option value="2000.00">10</option>
                                                                                                                                            </select>
                                                                      </font></font><font color="red" face="arial,helvetica,helv" size=2>                                                                      </font><font face="arial,helvetica,helv" size=2> Young Sponsor ticket(s) at $200 each</font>.
                                                                      <input type="hidden" name="item1" value="Headwater+Sponsor">
                                                                      <BR></font></p>
                                                                                                  </td>
                                                                                                      <td valign=top>
                                                                                                            </td>
                                                                                                </tr>
                                                                                                <tr>
                                                                                                      <td valign=top><p><input type="checkbox" name="check_item0" value="1" onclick="return box(check_item0, item0);">
                                                                                                        General Donation Non Attendence<br>
                                                                                                        $
                                                                        <input type="text" name="item_price0" value="0.00" size="6" maxlength="10" onblur="return calc();">
                                                                        Not able to attend but add a small gift.
                                                                        <input type="hidden" name="item2" value="Every+Drop+Counts">
                                                                        <BR>
                                                                                                        </p>
                                                                                                  </td>
                                                                                                      <td valign=top>
                                                                                                  </td>
                                                                                                </tr>
                                                                                                <tr>
                                                                                                      <td colspan="2" align="right" class="light"><input type="hidden" name="item_total" value="8"><font face="arial,helvetica,helv" size=2><br>
                                                                                                                  <!--  Total Amount: $<input size="8" name="total" value="0.00" readonly><br>-->Total : $<INPUT size="8" value="0.00" name="grand_total" readonly>
<input type="hidden" value="N" name="grand_total_passed"></td>
                                                                                                </tr>
                                                                                          </table>
                                                                                          <hr size=1>
                                                                                          <font size=2><B>Please enter Name(s) (as you wish to appear on donor list) or "anon" if you would like your gift to remain anonymous.</B>
                                                                                                <P><TEXTAREA name="comments" rows="1" cols="40" wrap="soft"></TEXTAREA>
                                                                                                <hr size=1>
                                                                                                <font size=2><B>Please choose a payment method:</B><BR>
                                                                                                      
To maximize your contribution to the Stroud Center, please consider making your gift in the form of an eCheck. Thank you. To learn more about the benefits to Stroud of your eCheck donation, <a href="echeck.htm" onClick="echeck=window.open('', 'echeck','resizable=yes,scrollbars=yes,status=yes,toolbar=no,location=no,directories=no,menubar=no,width=400,height=400');echeck.focus()" target="echeck"><B>click here</B></a>.
                                                                                                      <P>
                                                                                                      <table width=100%>
                                                                                                            <tr>
                                                                                                                  <td valign=top class="checkRight"><font face="arial,helvetica,helv" size=2><input type="radio" name="payment_type" value="echeck" checked>&nbsp;Electronic Check<BR>
                                                                                                                              <a href="check_help.htm" onClick="echeck=window.open('', 'echeck','resizable=yes,scrollbars=yes,status=yes,toolbar=no,location=no,directories=no,menubar=no,width=400,height=400');echeck.focus()" target="echeck"><font size="1" color="#ff0000">(Need Help?</a>)</font>
                                                                                                                        <P>
Check Number:<BR>
                                                                                                                              <INPUT size="11" name="ec_serial_number">
                                                                                                                        <P>
Routing Number:<BR>
                                                                                                                              <INPUT name="ec_rt" size="9" maxlength="9">
                                                                                                                        <P>
Account Number:<BR>
                                                                                                                              <INPUT name="ec_account">
                                                                                                                        <P>
Bank Name:<BR>
                                                                                                                              <INPUT name="ec_bank_name">
                                                                                                                        <P><INPUT name="ec_account_type" type="hidden" value="P">
<INPUT name="ec_id_type" type="hidden" value="GN">
<INPUT type="hidden" size="35" name="ec_id_number" value="none">
<INPUT type="hidden" name="ec_id_state" value="AL">


                                                                                                                  
                                                                                                            
                                                                                                      
                                                                                                </font></td>
                                                                              <td valign=top>&nbsp;&nbsp;&nbsp;
</td>
                                                                              <td valign=top><font face="arial,helvetica,helv" size=2><input type="radio" name="payment_type" value="cc">&nbsp;Credit Card
                                                            <P>
Credit Card Type:<BR>
                                                                  <select name="cc_type">
                                                                        <option></option>
                                                                        <option value="visa" >Visa</option>
                                                                        <option value="master" >Master Card</option>
                                                                  </select>
                                                            <P>Credit Card Number:<BR>
                                                                  <INPUT name="cc_num">
                                                            <P>
Security Code:
<a href="cc_help.htm" onClick="cc=window.open('', 'cc','resizable=yes,scrollbars=yes,status=yes,toolbar=no,location=no,directories=no,menubar=no,width=400,height=400');cc.focus()" target="cc"><font size="1" color="#ff0000">(What's This?)</font></a><BR>
                                                                  <INPUT name="cnp_security" maxlength="4" size="10"><BR>
                                                                  <INPUT type="checkbox" name="no_cnp_security" value="Y"> Check here if no security code
                                                                                          
                                                            <P>
Expiration Date:<br>
                                                                  <SELECT size="1" name="month">
                                                                        <P>
                                                                        <OPTION value="01" >1

                                                                                                      
                                                                        <OPTION value="02" >2

                                                                                                      
                                                                        <OPTION value="03" >3

                                                                                                      
                                                                        <OPTION value="04" >4

                                                                                                      
                                                                        <OPTION value="05" >5

                                                                                                      
                                                                        <OPTION value="06" >6

                                                                                                      
                                                                        <OPTION value="07" >7

                                                                                                      
                                                                        <OPTION value="08" >8

                                                                                                      
                                                                        <OPTION value="09" >9

                                                                                                      
                                                                        <OPTION value="10" >10

                                                                                                      
                                                                        <OPTION value="11" >11

                                                                                                      
                                                                        <OPTION value="12" >12</OPTION>
                                                                  </SELECT>
<SELECT size="1" name="year">
                                                                        <option value=2004>2004</option>
                                                                        <option value=2005>2005</option>
                                                                        <option value=2006>2006</option>
                                                                        <option value=2007>2007</option>
                                                                        <option value=2008>2008</option>
                                                                        <option value=2009>2009</option>
                                                                        <option value=2010>2010</option>
                                                                        <option value=2011>2011</option>
                                                                        <option value=2012>2012</option>
                                                                        <option value=2013>2013</option>
                                                              </SELECT>
   
                                                                                    
                                                      </font></td>
                                                                        </tr>
                                                                  </table>
                                                                  <hr size=1>
                                                                  <B>Donor Information</B><BR>
                                                                  
(If donating by credit card, please enter the name and address exactly as they appear on your bill.)<br>
                                                                  <hr size=1 width=150 align=left>
                                                                  <FONT color=red size=1>Red indicates required entries</FONT>
                                                                  <hr size=1 width=150 align=left>
                                                                  <P>
                                                                  <table cellspacing=0 cellpadding=1 border=0 bgcolor=ffffff>
                                                                        <tr>
                                                                              <td align=right valign=top><font face="arial,helv,helvetica" size=2><font color=red>First Name:</font></font></td>
                                                                              <td align=left valign=top><font face="arial,helv,helvetica" size=2><INPUT style="WIDTH: 130px; HEIGHT: 22px" size="14" name="billing_first_name">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<font color=red>Last Name:</font><INPUT style="WIDTH: 160px; HEIGHT: 22px" size="14" name="billing_last_name"></font></td>
                                                                        </tr>
                                                                        <tr>
                                                                              <td align=right valign=top><font face="arial,helv,helvetica" size=2>Company:</font></td>
                                                                              <td align=left valign=top><font face="arial,helv,helvetica" size=2><INPUT style="WIDTH: 245px; HEIGHT: 22px" maxlength="225" size="44" name="billing_company"></font></td>
                                                                        </tr>
                                                                        <tr>
                                                                              <td align=right valign=top><font face="arial,helv,helvetica" size=2><font color=red>Address:</font></font></td>
                                                                              <td align=left valign=top><font face="arial,helv,helvetica" size=2><INPUT style="WIDTH: 345px; HEIGHT: 22px" maxlength="225" size="44" name="billing_address"></font></td>
                                                                        </tr>
                                                                        <tr>
                                                                              <td align=right valign=top><font face="arial,helv,helvetica" size=2>Address:</font></td>
                                                                              <td align=left valign=top><font face="arial,helv,helvetica" size=2><INPUT style="WIDTH: 344px; HEIGHT: 22px" maxlength="225" size="44" name="billing_address2"></font></td>
                                                                        </tr>
                                                                        <tr>
                                                                              <td align=right valign=top><font face="arial,helv,helvetica" size=2><font color=red>City:</font></font></td>
                                                                              <td align=left valign=top><font face="arial,helv,helvetica" size=2><INPUT name="billing_city"></font></td>
                                                                        </tr>
                                                                        <tr>
                                                                              <td align=right valign=top><font face="arial,helv,helvetica" size=2>State:</font></td>
                                                                              <td align=left valign=top><font face="arial,helv,helvetica" size=2><SELECT name="billing_state" >
                                                                                                <option value=""></option>
                                                                                                <option value=""></option>
                                                                                                <option value="AL">Alabama</option>
                                                                                                <option value="AK">Alaska</option>
                                                                                                <option value="AS">American Samoa</option>
                                                                                                <option value="AZ">Arizona</option>
                                                                                                <option value="AR">Arkansas</option>
                                                                                                <option value="AA">Armed Forces - Americas (ex. Canada)</option>
                                                                                                <option value="AE">Armed Forces - Canada & all others</option>
                                                                                                <option value="AP">Armed Forces - Pacific</option>
                                                                                                <option value="CA">California</option>
                                                                                                <option value="CO">Colorado</option>
                                                                                                <option value="CT">Connecticut</option>
                                                                                                <option value="DE">Delaware</option>
                                                                                                <option value="DC">District of Columbia</option>
                                                                                                <option value="FL">Florida</option>
                                                                                                <option value="GA">Georgia</option>
                                                                                                <option value="GU">Guam</option>
                                                                                                <option value="HI">Hawaii</option>
                                                                                                <option value="ID">Idaho</option>
                                                                                                <option value="IL">Illinois</option>
                                                                                                <option value="IN">Indiana</option>
                                                                                                <option value="IA">Iowa</option>
                                                                                                <option value="KS">Kansas</option>
                                                                                                <option value="KY">Kentucky</option>
                                                                                                <option value="LA">Louisiana</option>
                                                                                                <option value="ME">Maine</option>
                                                                                                <option value="MP">Mariana Islands</option>
                                                                                                <option value="MH">Marshall Islands</option>
                                                                                                <option value="MD">Maryland</option>
                                                                                                <option value="MA">Massachusetts</option>
                                                                                                <option value="MI">Michigan</option>
                                                                                                <option value="FM">Micronesia</option>
                                                                                                <option value="MN">Minnesota</option>
                                                                                                <option value="MS">Mississippi</option>
                                                                                                <option value="MO">Missouri</option>
                                                                                                <option value="MT">Montana</option>
                                                                                                <option value="NE">Nebraska</option>
                                                                                                <option value="NV">Nevada</option>
                                                                                                <option value="NH">New Hampshire</option>
                                                                                                <option value="NJ">New Jersey</option>
                                                                                                <option value="NM">New Mexico</option>
                                                                                                <option value="NY">New York</option>
                                                                                                <option value="NC">North Carolina</option>
                                                                                                <option value="ND">North Dakota</option>
                                                                                                <option value="OH">Ohio</option>
                                                                                                <option value="OK">Oklahoma</option>
                                                                                                <option value="OR">Oregon</option>
                                                                                                <option value="PA">Pennsylvania</option>
                                                                                                <option value="PR">Puerto Rico</option>
                                                                                                <option value="RI">Rhode Island</option>
                                                                                                <option value="SC">South Carolina</option>
                                                                                                <option value="SD">South Dakota</option>
                                                                                                <option value="TN">Tennessee</option>
                                                                                                <option value="TX">Texas</option>
                                                                                                <option value="UT">Utah</option>
                                                                                                <option value="VT">Vermont</option>
                                                                                                <option value="VI">Virgin Islands</option>
                                                                                                <option value="VA">Virginia</option>
                                                                                                <option value="WA">Washington</option>
                                                                                                <option value="WV">West Virginia</option>
                                                                                                <option value="WI">Wisconsin</option>
                                                                                                <option value="WY">Wyoming</option>
                                                                                          </SELECT>&nbsp;<font size="1" color=red>required for USA</font></font></td>
                                                                        </tr>
                                                                        <tr>
                                                                              <td align=right valign=top><font face="arial,helv,helvetica" size=2>Province:</font></td>
                                                                              <td align=left valign=top><font face="arial,helv,helvetica" size=2><input type="text" name="billing_province" maxlength="30" size=30>&nbsp;<font size="1" color=red>required for Canada</font></font></td>
                                                                        </tr>
                                                                        <tr>
                                                                              <td align=right valign=top><font face="arial,helv,helvetica" size=2>Postal Code:</font></td>
                                                                              <td align=left valign=top><font face="arial,helv,helvetica" size=2><INPUT maxlength="10" size="10" name="billing_zip">&nbsp;<font size="1" color=red>required for USA and Can</font><font face="arial,helv,helvetica" size=2>
                                                                                <input name="billing_email">
                                                                              </font><font size="1" color=red>ada</font></font></td>
                                                                        </tr>
                                                                        <tr>
                                                                              <td align=right valign=top><font face="arial,helv,helvetica" size=2><font color=red>Country:</font></font></td>
                                                                              <td align=left valign=top><font face="arial,helv,helvetica" size=2><select style="WIDTH: 398px; HEIGHT: 22px" name="billing_country">
                                                                                                <option value=""></option>
                                                                                                <option value="AF">Afghanistan</option>
                                                                                                <option value="AL">Albania</option>
                                                                                                <option value="DZ">Algeria</option>
                                                                                                <option value="AS">American Samoa</option>
                                                                                                <option value="AD">Andorra</option>
                                                                                                <option value="AO">Angola</option>
                                                                                                <option value="AI">Anguilla</option>
                                                                                                <option value="AQ">Antarctica</option>
                                                                                                <option value="AG">Antigua and Barbuda</option>
                                                                                                <option value="AR">Argentina</option>
                                                                                                <option value="AM">Armenia</option>
                                                                                                <option value="AW">Aruba</option>
                                                                                                <option value="AU">Australia</option>
                                                                                                <option value="AT">Austria</option>
                                                                                                <option value="AZ">Azerbaijan</option>
                                                                                                <option value="BS">Bahamas</option>
                                                                                                <option value="BH">Bahrain</option>
                                                                                                <option value="BD">Bangladesh</option>
                                                                                                <option value="BB">Barbados</option>
                                                                                                <option value="BY">Belarus</option>
                                                                                                <option value="BE">Belgium</option>
                                                                                                <option value="BZ">Belize</option>
                                                                                                <option value="BJ">Benin</option>
                                                                                                <option value="BM">Bermuda</option>
                                                                                                <option value="BT">Bhutan</option>
                                                                                                <option value="BO">Bolivia</option>
                                                                                                <option value="BA">Bosnia and Herzegowina</option>
                                                                                                <option value="BW">Botswana</option>
                                                                                                <option value="BV">Bouvet Island</option>
                                                                                                <option value="BR">Brazil</option>
                                                                                                <option value="IO">British Indian Ocean Territory</option>
                                                                                                <option value="BN">Brunei Darussalam</option>
                                                                                                <option value="BG">Bulgaria</option>
                                                                                                <option value="BF">Burkina Faso</option>
                                                                                                <option value="BI">Burundi</option>
                                                                                                <option value="KH">Cambodia</option>
                                                                                                <option value="CM">Cameroon</option>
                                                                                                <option value="CA">Canada</option>
                                                                                                <option value="CV">Cape Verde</option>
                                                                                                <option value="KY">Cayman Islands</option>
                                                                                                <option value="CF">Central African Republic</option>
                                                                                                <option value="TD">Chad</option>
                                                                                                <option value="CL">Chile</option>
                                                                                                <option value="CN">China</option>
                                                                                                <option value="CX">Christmas Island</option>
                                                                                                <option value="CC">Cocos (Keeling) Islands</option>
                                                                                                <option value="CO">Colombia</option>
                                                                                                <option value="KM">Comoros</option>
                                                                                                <option value="CG">Congo</option>
                                                                                                <option value="CK">Cook Islands</option>
                                                                                                <option value="CR">Costa Rica</option>
                                                                                                <option value="CI">Cote D'Ivoire</option>
                                                                                                <option value="HR">Croatia</option>
                                                                                                <option value="CU">Cuba</option>
                                                                                                <option value="CY">Cyprus</option>
                                                                                                <option value="CZ">Czech Republic</option>
                                                                                                <option value="DK">Denmark</option>
                                                                                                <option value="DJ">Djibouti</option>
                                                                                                <option value="DM">Dominica</option>
                                                                                                <option value="DO">Dominican Republic</option>
                                                                                                <option value="TP">East Timor</option>
                                                                                                <option value="EC">Ecuador</option>
                                                                                                <option value="EG">Egypt</option>
                                                                                                <option value="SV">El Salvador</option>
                                                                                                <option value="GQ">Equatorial Guinea</option>
                                                                                                <option value="ER">Eritrea</option>
                                                                                                <option value="EE">Estonia</option>
                                                                                                <option value="ET">Ethiopia</option>
                                                                                                <option value="FK">Falkland Islands (Malvinas)</option>
                                                                                                <option value="FO">Faroe Islands</option>
                                                                                                <option value="FJ">Fiji</option>
                                                                                                <option value="FI">Finland</option>
                                                                                                <option value="FR">France</option>
                                                                                                <option value="FX">France, MEtropolitan</option>
                                                                                                <option value="GF">French Guiana</option>
                                                                                                <option value="PF">French Polynesia</option>
                                                                                                <option value="TF">French Southern Territories</option>
                                                                                                <option value="GA">Gabon</option>
                                                                                                <option value="GM">Gambia</option>
                                                                                                <option value="GE">Georgia</option>
                                                                                                <option value="DE">Germany</option>
                                                                                                <option value="GH">Ghana</option>
                                                                                                <option value="GI">Gibraltar</option>
                                                                                                <option value="GR">Greece</option>
                                                                                                <option value="GL">Greenland</option>
                                                                                                <option value="GD">Grenada</option>
                                                                                                <option value="GP">Guadeloupe</option>
                                                                                                <option value="GU">Guam</option>
                                                                                                <option value="GT">Guatemala</option>
                                                                                                <option value="GN">Guinea</option>
                                                                                                <option value="GW">Guinea-bissau</option>
                                                                                                <option value="GY">Guyana</option>
                                                                                                <option value="HT">Haiti</option>
                                                                                                <option value="HM">Heard and Mc Donald Islands</option>
                                                                                                <option value="HN">Honduras</option>
                                                                                                <option value="HK">Hong Kong</option>
                                                                                                <option value="HU">Hungary</option>
                                                                                                <option value="IS">Iceland</option>
                                                                                                <option value="IN">India</option>
                                                                                                <option value="ID">Indonesia</option>
                                                                                                <option value="IR">Iran (Islamic Republic of)</option>
                                                                                                <option value="IQ">Iraq</option>
                                                                                                <option value="IE">Ireland</option>
                                                                                                <option value="IL">Israel</option>
                                                                                                <option value="IT">Italy</option>
                                                                                                <option value="JM">Jamaica</option>
                                                                                                <option value="JP">Japan</option>
                                                                                                <option value="JO">Jordan</option>
                                                                                                <option value="KZ">Kazakhstan</option>
                                                                                                <option value="KE">Kenya</option>
                                                                                                <option value="KI">Kiribati</option>
                                                                                                <option value="KP">Korea, Democratic People's Republic of</option>
                                                                                                <option value="KR">Korea, Republic of</option>
                                                                                                <option value="KW">Kuwait</option>
                                                                                                <option value="KG">Kyrgyzstan</option>
                                                                                                <option value="LA">Lao People's Democratic Republic</option>
                                                                                                <option value="LV">Latvia</option>
                                                                                                <option value="LB">Lebanon</option>
                                                                                                <option value="LS">Lesotho</option>
                                                                                                <option value="LR">Liberia</option>
                                                                                                <option value="LY">Libyan Arab Jamahiriya</option>
                                                                                                <option value="LI">Liechtenstein</option>
                                                                                                <option value="LT">Lithuania</option>
                                                                                                <option value="LU">Luxembourg</option>
                                                                                                <option value="MO">Macau</option>
                                                                                                <option value="MK">Macedonia, The Former Yugoslav Republic of</option>
                                                                                                <option value="MG">Madagascar</option>
                                                                                                <option value="MW">Malawi</option>
                                                                                                <option value="MY">Malaysia</option>
                                                                                                <option value="MV">Maldives</option>
                                                                                                <option value="ML">Mali</option>
                                                                                                <option value="MT">Malta</option>
                                                                                                <option value="MH">Marshall Islands</option>
                                                                                                <option value="MQ">Martinique</option>
                                                                                                <option value="MR">Mauritania</option>
                                                                                                <option value="MU">Mauritius</option>
                                                                                                <option value="YT">Mayotte</option>
                                                                                                <option value="MX">Mexico</option>
                                                                                                <option value="FM">Micronesia, Federated States of</option>
                                                                                                <option value="MD">Moldova, Republic of</option>
                                                                                                <option value="MC">Monaco</option>
                                                                                                <option value="MN">Mongolia</option>
                                                                                                <option value="MS">Montserrat</option>
                                                                                                <option value="MA">Morocco</option>
                                                                                                <option value="MZ">Mozambique</option>
                                                                                                <option value="MM">Myanmar</option>
                                                                                                <option value="NA">Namibia</option>
                                                                                                <option value="NR">Nauru</option>
                                                                                                <option value="NP">Nepal</option>
                                                                                                <option value="NL">Netherlands</option>
                                                                                                <option value="AN">Netherlands Antilles</option>
                                                                                                <option value="NC">New Caledonia</option>
                                                                                                <option value="NZ">New Zealand</option>
                                                                                                <option value="NI">Nicaragua</option>
                                                                                                <option value="NE">Niger</option>
                                                                                                <option value="NG">Nigeria</option>
                                                                                                <option value="NU">Niue</option>
                                                                                                <option value="NF">Norfolk Island</option>
                                                                                                <option value="MP">Northern Mariana Islands</option>
                                                                                                <option value="NO">Norway</option>
                                                                                                <option value="OM">Oman</option>
                                                                                                <option value="PK">Pakistan</option>
                                                                                                <option value="PW">Palau</option>
                                                                                                <option value="PA">Panama</option>
                                                                                                <option value="PG">Papua New Guinea</option>
                                                                                                <option value="PY">Paraguay</option>
                                                                                                <option value="PE">Peru</option>
                                                                                                <option value="PH">Philippines</option>
                                                                                                <option value="PN">Pitcairn</option>
                                                                                                <option value="PL">Poland</option>
                                                                                                <option value="PT">Portugal</option>
                                                                                                <option value="PR">Puerto Rico</option>
                                                                                                <option value="QA">Qatar</option>
                                                                                                <option value="RE">Reunion</option>
                                                                                                <option value="RO">Romania</option>
                                                                                                <option value="RU">Russian Federation</option>
                                                                                                <option value="RW">Rwanda</option>
                                                                                                <option value="KN">Saint Kitts and Nevis</option>
                                                                                                <option value="LC">Saint Lucia</option>
                                                                                                <option value="VC">Saint Vincent and the Grenadines</option>
                                                                                                <option value="WS">Samoa</option>
                                                                                                <option value="SM">San Marino</option>
                                                                                                <option value="ST">Sao Tome and Principe</option>
                                                                                                <option value="SA">Saudi Arabia</option>
                                                                                                <option value="SN">Senegal</option>
                                                                                                <option value="SC">Seychelles</option>
                                                                                                <option value="SL">Sierra Leone</option>
                                                                                                <option value="SG">Singapore</option>
                                                                                                <option value="SK">Slovakia (Slovak Republic)</option>
                                                                                                <option value="SI">Slovenia</option>
                                                                                                <option value="SB">Solomon Islands</option>
                                                                                                <option value="SO">Somalia</option>
                                                                                                <option value="ZA">South Africa</option>
                                                                                                <option value="GS">South Georgia and the South Sandwich Islands</option>
                                                                                                <option value="ES">Spain</option>
                                                                                                <option value="LK">Sri Lanka</option>
                                                                                                <option value="SH">St. Helena</option>
                                                                                                <option value="PM">St. Pierre and Miquelon</option>
                                                                                                <option value="SD">Sudan</option>
                                                                                                <option value="SR">Suriname</option>
                                                                                                <option value="SJ">Svalbard and Jan Mayen Islands</option>
                                                                                                <option value="SZ">Swaziland</option>
                                                                                                <option value="SE">Sweden</option>
                                                                                                <option value="CH">Switzerland</option>
                                                                                                <option value="SY">Syrian Arab Republic</option>
                                                                                                <option value="TW">Taiwan, Province of China</option>
                                                                                                <option value="TJ">Tajikistan</option>
                                                                                                <option value="TZ">Tanzania, United Republic of</option>
                                                                                                <option value="TH">Thailand</option>
                                                                                                <option value="TG">Togo</option>
                                                                                                <option value="TK">Tokelau</option>
                                                                                                <option value="TO">Tonga</option>
                                                                                                <option value="TT">Trinidad and Tobago</option>
                                                                                                <option value="TN">Tunisia</option>
                                                                                                <option value="TR">Turkey</option>
                                                                                                <option value="TM">Turkmenistan</option>
                                                                                                <option value="TC">Turks and Caicos Islands</option>
                                                                                                <option value="TV">Tuvalu</option>
                                                                                                <option value="UG">Uganda</option>
                                                                                                <option value="UA">Ukraine</option>
                                                                                                <option value="AE">United Arab Emirates</option>
                                                                                                <option value="GB">United Kingdom</option>
                                                                                                <option value="US" selected>United States</option>
                                                                                                <option value="UM">United States Minor Outlying Islands</option>
                                                                                                <option value="UY">Uruguay</option>
                                                                                                <option value="UZ">Uzbekistan</option>
                                                                                                <option value="VU">Vanuatu</option>
                                                                                                <option value="VA">Vatican City State (Holy See)</option>
                                                                                                <option value="VE">Venezuela</option>
                                                                                                <option value="VN">Viet Nam</option>
                                                                                                <option value="VG">Virgin Islands (British)</option>
                                                                                                <option value="VI">Virgin Islands (U.S.)</option>
                                                                                                <option value="WF">Wallis and Futuna Islands</option>
                                                                                                <option value="EH">Western Sahara</option>
                                                                                                <option value="YE">Yemen</option>
                                                                                                <option value="YU">Yugoslavia</option>
                                                                                                <option value="ZR">Zaire</option>
                                                                                                <option value="ZM">Zambia</option>
                                                                                                <option value="ZW">Zimbabwe</option>
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