Sample Donation Form

[This is where you can have a custom header for your donation form.]

^* Required Fields

First Name:^*
Last Name:^*
Company Name:^*
Leave Blank:
Address:^*

City:^*
Province/State:^*
Country:^*
Postal/ZIP Code:^*
Phone:^*	( ) Ext.
Email:^*

Optional checkbox Another checkbox
Type of donation:	Individual Corporate
Fund Designation:

Amount:^* (All funds charged in Canadian dollars) $25 $50 $75 $100 Other: $

Credit Card Information

Card Type: ^*
Card Number:^*
CVV:^*	What is this?
Cardholder Name:^*
Expiry Date:^*

Please click Submit button only once

[This is where you can have a custom footer for your donation form.]

Sample Donations International
1234 Imaginary Avenue
Sampleville, BC
A1A 1A1

To ensure the security of your personal information your credit card information is processed securely in real time using the latest available encryption technology. IATS Ticketmaster is compliant under Payment Card Industry Data Security Standards (PCI). Look for the locked lock on your browser's status bar to ensure you are submitting your payment information on a secure form.