source_form_ID_13601719515

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<form class="jotform-form" action="http://submit.jotform.com/submit.php" method="post" name="form_13601719515" id="13601719515" accept-charset="utf-8">
  <input type="hidden" name="formID" value="13601719515" />
  <div class="form-all">
    <ul class="form-section">
      <li class="form-line" id="id_1">
        <label class="form-label-top" id="label_1" for="input_1"> Select Gift Amount: </label>
        <div id="cid_1" class="form-input-wide">
          <div class="form-single-column"><span class="form-radio-item" style="clear:left;"><input type="radio" class="form-radio" id="input_1_0" name="q1_selectGift1" value="$25.00" onclick="displaySelection(this.value); document.getElementById('input_3_0').focus();" />
              <label for="input_1_0"> $25.00 </label></span><span class="clearfix"></span><span class="form-radio-item" style="clear:left;"><input type="radio" class="form-radio" id="input_1_1" name="q1_selectGift1" value="$50.00" onclick="displaySelection(this.value); document.getElementById('input_3_0').focus();" />
              <label for="input_1_1"> $50.00 </label></span><span class="clearfix"></span><span class="form-radio-item" style="clear:left;"><input type="radio" class="form-radio" id="input_1_2" name="q1_selectGift1" value="$100.00" onclick="displaySelection(this.value); document.getElementById('input_3_0').focus();" />
              <label for="input_1_2"> $100.00 </label></span><span class="clearfix"></span><span class="form-radio-item" style="clear:left;"><input type="radio" class="form-radio" id="input_1_3" name="q1_selectGift1" value="$250.00" onclick="displaySelection(this.value); document.getElementById('input_3_0').focus();" />
              <label for="input_1_3"> $250.00 </label></span><span class="clearfix"></span><span class="form-radio-item" style="clear:left;"><input type="radio" class="form-radio" id="input_1_4" name="q1_selectGift1" value="$500.00" onclick="displaySelection(this.value); document.getElementById('input_3_0').focus();" />
              <label for="input_1_4"> $500.00 </label></span><span class="clearfix"></span><span class="form-radio-item" style="clear:left;"><input type="radio" class="form-radio" id="input_1_5" name="q1_selectGift1" value="I want to enter my own amount." onclick="document.getElementById('input_2_donation').focus();" />
              <label for="input_1_5"> I want to enter my own amount. </label></span><span class="clearfix"></span>
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        </div>
      </li>
      <li class="form-line" id="id_2">
        <label class="form-label-right" id="label_2" for="input_2"> Donation </label>
        <div id="cid_2" class="form-input"><span class="form-sub-label-container"><input type="text" class="form-textbox validate[required, Numeric]" size="4" id="input_2_donation" name="q2_donation[price]" value="" onfocus="this.value='';">
            USD
            <label class="form-sub-label" for="input_2_donation"> Please enter an amount of $10.00 or more,<br />omitting the "$" symbol </label></span>
        </div>
      </li>
      <li class="form-line" id="id_3">
        <label class="form-label-right" id="label_3" for="input_3"> Repeat monthly </label>
        <div id="cid_3" class="form-input">
          <div class="form-single-column"><span class="form-checkbox-item" style="clear:left;"><input type="checkbox" class="form-checkbox" id="input_3_0" name="q3_repeatMonthly3[]" value="Automatically repeat this gift every month." />
              <label for="input_3_0"> Automatically repeat this gift every month. </label></span><span class="clearfix"></span>
          </div>
        </div>
      </li>
      <li class="form-line" id="id_4">
        <div id="cid_4" class="form-input-wide">
          <div style="text-align:left" class="form-buttons-wrapper">
            <button id="input_4" type="submit" class="form-submit-button">
              DONATE
            </button>
          </div>
        </div>
      </li>
      <li style="display:none">
        Should be Empty:
        <input type="text" name="website" value="" />
      </li>
    </ul>
  </div>
  <input type="hidden" id="simple_spc" name="simple_spc" value="13601719515" />
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</form>