Online Giving

Bill To Information     
Company Name:  
*First Name:  
*Last Name:  
*Address:  
Address 2:  
*City:  
*State:  
*Zip:  
*Phone:  
   (Please enter as nnn-nnn-nnnn where n is a number.)
*Email:  
Credit Card Information     
*Credit Card Type:  
*Name on Card:  
*Card Number:  
*Expiration Month (nn):  
*Expiration Year (nnnn):  
  
*Enter Code:  
  
[insert_php] $_POST[“pg_merchant_data_1”] = “”;
$_POST[“pg_merchant_data_2”] = $recipientid;
$_POST[“pg_merchant_data_3”] = $recipient;
$_POST[“pg_merchant_data_4”] = $recipientrc;
$_POST[“pg_ts_hash”] = $hash;
$_POST[“pg_utc_time”] = $utc;
echo “hash=” . htmlspecialchars($_POST[“pg_ts_hash”]);
echo “recipient=” . htmlspecialchars($_POST[“pg_merchant_data_3”]);
[/insert_php]









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