HTML Code:
<HTML>
<HEAD>
<TITLE>Contribution / Donations Form</TITLE>
</HEAD>
<BODY bgcolor="#33ffcc" LINK="red" VLINK="red" topmargin="0" leftmargin="0" marginwidth="0" marginheight="0" rightmargin="0">
<SCRIPT>
function validate() {
mNv1=donationform.xname.value;
mNv2=donationform.xemail.value;
mNv3=donationform.xaddress.value;
mNv4=donationform.xcity.value;
mNv5=donationform.xstate.value;
mNv6=donationform.xzip.value;
mNv7=donationform.xother.value;
if (mNv1=='') {
alert('Name is a required field. Please try again.');
event.returnValue=false;
}
if (mNv2=='') {
alert('Email is a required field. Please try again.');
event.returnValue=false;
}
if (mNv3=='') {
alert('Address is a required field. Please try again.');
event.returnValue=false;
}
if (mNv4=='') {
alert('City is a required field. Please try again.');
event.returnValue=false;
}
if (mNv5=='') {
alert('State is a required field. Please try again.');
event.returnValue=false;
}
if (mNv6=='') {
alert('Zip is a required field. Please try again.');
event.returnValue=false;
}
if ((donationform.donation[5].checked && mNv7=='' )) {
alert('Please enter an Other Amount');
event.returnValue=false;
}
if (!(donationform.donation[0].checked || donationform.donation[1].checked || donationform.donation[2].checked || donationform.donation[3].checked || donationform.donation[4].checked || donationform.donation[5].checked )) {
alert('Donation box is a required field.');
event.returnValue=false;
}
}
</SCRIPT>
<TABLE width="100%" BORDER="0" CELLSPACING="0" CELLPADDING="10">
<TR>
<TD>
<FONT FACE="Arial,sans-serif" SIZE="2" COLOR="black">
We would be delighted if you would contribute to the Oconee Regional Humane Society. This
will make you a part of our team helping the needy animals in our community. You will also
receive a quarterly newsletter to keep you up to date on our activities and our plans.
Complete the form and click "Submit".
</FONT>
<FONT FACE="Arial,sans-serif" SIZE="2" COLOR="red">
*
</FONT>
<FONT FACE="Arial,sans-serif" SIZE="2" COLOR="black">
= Required field.
</FONT>
</TD>
</TR>
</TABLE>
<form NAME="donationform" method="post" action="donation.php" id="Form" onsubmit="validate();">
<TABLE width="100%" BORDER="0" CELLSPACING="0" CELLPADDING="0">
<tr valign="top">
<td>
<FONT FACE="Arial,sans-serif" SIZE="3" COLOR="black">
<b> Yes! I wish to become a contributor to the<br>
Oconee Regional Humane Society.</b><br><br>
<i><b> All Donations are tax deductible<br>
Your cancelled check is your receipt</b></i><br><br>
</FONT>
<FONT FACE="Arial,sans-serif" SIZE="5" COLOR="red"> * </FONT>
<FONT FACE="Arial,sans-serif" SIZE="3" COLOR="black">
Name:
<input type="text" name="xname" value="" size="50" maxlength="50"><br>
</FONT>
<FONT FACE="Arial,sans-serif" SIZE="5" COLOR="red"> * </FONT>
<FONT FACE="Arial,sans-serif" SIZE="3" COLOR="black">
Address:
<input type="text" name="xaddress" value="" size="50" maxlength="70"><br>
</FONT>
<FONT FACE="Arial,sans-serif" SIZE="5" COLOR="red"> * </FONT>
<FONT FACE="Arial,sans-serif" SIZE="3" COLOR="black">
City:
<input type="text" name="xcity" value="" size="20" maxlength="30"><br>
</FONT>
<FONT FACE="Arial,sans-serif" SIZE="5" COLOR="red"> * </FONT>
<FONT FACE="Arial,sans-serif" SIZE="3" COLOR="black">
State:
<input type="text" name="xstate" value="GA" size="2" maxlength="20"><br>
</FONT>
<FONT FACE="Arial,sans-serif" SIZE="5" COLOR="red"> * </FONT>
<FONT FACE="Arial,sans-serif" SIZE="3" COLOR="black">
Zip:
<input type="text" name="xzip" value="" size="5" maxlength="10"><br>
</FONT>
<FONT FACE="Arial,sans-serif" SIZE="5" COLOR="red"> * </FONT>
<FONT FACE="Arial,sans-serif" SIZE="3" COLOR="black">
Email:
<input type="text" name="xemail" value="" size="40" maxlength="50"><br>
</FONT>
<FONT FACE="Arial,sans-serif" SIZE="1" COLOR="black">
We will NEVER share your email address with others<br>
</FONT>
<FONT FACE="Arial,sans-serif" SIZE="5" COLOR="#33ffcc"> * </FONT>
<FONT FACE="Arial,sans-serif" SIZE="3" COLOR="black">
Phone:
<input type="text" name="xphone" value="" size="20" maxlength="20">
<br>
</td>
<td>
<FONT FACE="Arial,sans-serif" SIZE="4" COLOR="red"> * </FONT>
<FONT FACE="Arial,sans-serif" SIZE="3" COLOR="black">
Donation:<br>
<input type="radio" name="donation" value="$40 - Vaccinations and Tests"> $40 - Vaccinations and Tests<br>
<input type="radio" name="donation" value="$85 - Spay/Neuter"> $85 - Spay/Neuter<br>
<input type="radio" name="donation" value="$100 - 1 Animal's Expenses from Rescue to Placement"> $100 - 1 Animal's Expenses from Rescue to Placement<br>
<input type="radio" name="donation" value="$300 - Emergency Medical Expenses"> $300 - Emergency Medical Expenses<br>
<input type="radio" name="donation" value="$1000 - Life Saver"> $1000 - Life Saver<br>
<input type="radio" name="donation" value="Any amount helps local animals and is appreciated"> Any amount helps local animals and is appreciated<br>
Other amount:
<input type="text" name="xother" value="" size="20" maxlength="20"><br><br>
I am interested in volunteering in the following areas.<br>
Check All you are interested in:<br>
<input type="checkbox" name="funds" value="Fund Raising / Special Events,"> Fund Raising / Special Events<br>
<input type="checkbox" name="education" value="Education,"> Education<br>
<input type="checkbox" name="building" value="Building Committee,"> Building Committee<br>
<input type="checkbox" name="transportation" value="Transportation,"> Transportation<br>
<input type="checkbox" name="adoption" value="Adoption Days,"> Adoption Days<br>
<input type="checkbox" name="foster" value="Foster Homes,"> Foster Homes<br><br>
<INPUT type="Submit" VALUE="Submit Information">
</FONT>
<FONT FACE="Arial,sans-serif" SIZE="1" COLOR="black">
You will receive an email with further instructions
</FONT>
</td>
</tr>
</table>
</form>
</BODY>
</HTML>
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