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<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Donation Form</title>
<style>
body {
font-family: Arial, sans-serif;
margin: 40px;
}
h2,
h3 {
color: #8B0000;
}
label {
display: inline-block;
/* width: 150px;
margin-top: 8px; */
}
input,
select {
/* margin-top: 6px;
padding: 5px; */
}
.section {
margin-bottom: 30px;
}
</style>
</head>
<body>
<h2>* Denotes Required Information</h2>
<div>
<ul>
<li>> 1 Donation</li>
<li>> 2 Confirmation</li>
<li>> Thank You!</li>
</ul>
</div>
<div class="section">
<h3>Donor Information</h3>
<form>
<label>First Name*</label>
<input type=""><br>
<label>Last Name*</label>
<input type="text"><br>
<label>Company</label>
<input type="text"><br>
<label>Address 1*</label>
<input type="text"><br>
<label>Address 2</label>
<input type="text"><br>
<label>City*</label>
<input type="text"><br>
<label>State*</label>
<select>
<option>Select a State</option>
<option>California</option>
<option>New York</option>
<option>Texas</option>
<option>Florida</option>
</select><br>
<label>Zip Code*</label>
<input type="text"><br>
<label>Country*</label>
<select>
<option>Select a Country</option>
<option>USA</option>
<option>Canada</option>
<option>UK</option>
<option>Bangladesh</option>
</select><br>
<label>Phone</label>
<input type="tel" name="phone"><br>
<label>Fax</label>
<input type="text" name="fax"><br>
<label>Email*</label>
<input type="email"><br>
<label>Donation Amount*</label>
<input type="radio"> None
<input type="radio"> $50
<input type="radio"> $75
<input type="radio"> $100
<input type="radio"> $250
<input type="radio"> Other<br>
<label>Other Amount $</label>
<input type="number"><br>
<input type="checkbox" name="recurring"> I am interested in giving on a regular basis.<br>
<label>Monthly Credit Card $</label>
<input type="number">
<label>For</label>
<input type="number"> Months<br>
</form>
</div>
<div class="section">
<h3>Honorarium and Memorial Donation Information</h3>
<form>
<label>I would like to make this donation:</label>
<input type="radio" name="honor" value="honor"> To Honor
<input type="radio" name="honor" value="memory"> In Memory of<br>
<label>Name</label>
<input type="text"><br>
<label>Acknowledge Donation to:</label>
<input type="text"><br>
<label>Address</label>
<input type="text"><br>
<label>City</label>
<input type="text"><br>
<label>State</label>
<select>
<option>Select a State</option>
<option>California</option>
<option>New York</option>
<option>Texas</option>
<option>Florida</option>
</select><br>
<label>Zip</label>
<input type="text"><br>
</div>
<div class="section">
<h3>Additional Information</h3>
<label>Please enter your name, company or organization as you would like it to appear in our
publications</label><br>
<input type="text"><br>
<input type="checkbox"> I would like my gift to remain anonymous.<br>
<input type="checkbox"> My employer offers a matching gift program. I will mail the
matching gift form.<br>
<input type="checkbox" name="savecost"> Please save the cost of acknowledging this gift by not mailing a
thank you letter.<br><br>
<label>Comments (Please type any questions or feedback here):</label><br>
<textarea name="comments"></textarea><br>
<h3>How may we contact you?</h3>
<input type="checkbox"> E-mail<br>
<input type="checkbox"> Postal Mail<br>
<input type="checkbox"> Telephone<br>
<input type="checkbox"> Fax<br><br>
<label for="">I would like to receive newsletters and information about
special events by</label>
<input type="checkbox" name=""> E-mail
<input type="checkbox" name=""> Postal Mail<br><br>
<input type="checkbox"> I would like information about volunteering with the
organization.<br><br>
<input type="reset" value="Reset">
<input type="submit" value="Continue">
</form>
</div>
</body>
</html>
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