<div id="donation-form-container"> <form id="donation-form" class="donation-form" method="post" onsubmit="event.preventDefault(); collectPayment();"> <div class="ct-initial-view"> <div class="ct-initial-view-inner"> <div class="ct-donation-box"> <div class="section donation"> <h3>Make Your Mark in Our New Chabad Center</h3> <div class="ct-donation-levels"> <div class="ct-amount-container field radio 163840 required"> <label for="163840"> <input id="163840" name="donation-level" class="required" type="radio" value="700000.000000" maxlength="255"> <div class="ct-label-container"> <span class="label"><strong>$700,000</strong> Dedicate Social Hall </span> </div> </label> </div> <div class="ct-amount-container field radio 163841 required"> <label for="163841"> <input id="163841" name="donation-level" class="required" type="radio" value="350000.000000" maxlength="255"> <div class="ct-label-container"> <span class="label"><strong>$350,000</strong> Dedicate Charlotte's Largest Kosher Commercial Kitchen </span> </div> </label> </div> <div class="ct-amount-container field radio 163842 required"> <label for="163842"> <input id="163842" name="donation-level" class="required" type="radio" value="150000.000000" maxlength="255"> <div class="ct-label-container"> <span class="label"><strong>$150,000</strong> Dedicate Library & Conference Room </span> </div> </label> </div> <div class="ct-amount-container field radio 163843 required"> <label for="163843"> <input id="163843" name="donation-level" class="required" type="radio" value="60000.000000" maxlength="255"> <div class="ct-label-container"> <span class="label"><strong>$60,000</strong> Dedicate Chabad Outreach Office </span> </div> </label> </div> <div class="ct-amount-container field radio 163844 required"> <label for="163844"> <input id="163844" name="donation-level" class="required" type="radio" value="50000.000000" maxlength="255"> <div class="ct-label-container"> <span class="label"><strong>$50,000</strong> Dedicate Children's Library & Play Area </span> </div> </label> </div> <div class="ct-amount-container field radio 163845 required"> <label for="163845"> <input id="163845" name="donation-level" class="required" type="radio" value="40000.000000" maxlength="255"> <div class="ct-label-container"> <span class="label"><strong>$40,000</strong> Dedicate Youth Minyan Ark & Furniture </span> </div> </label> </div> <div class="ct-amount-container field radio 163846 required"> <label for="163846"> <input id="163846" name="donation-level" class="required" type="radio" value="25000.000000" maxlength="255"> <div class="ct-label-container"> <span class="label"><strong>$25,000</strong> Dedicate Administrative Office </span> </div> </label> </div> <div class="ct-amount-container field radio 163847 required"> <label for="163847"> <input id="163847" name="donation-level" class="required" type="radio" value="3600.000000" maxlength="255"> <div class="ct-label-container"> <span class="label"><strong>$3,600</strong> Dedicate Synagogue Pew </span> </div> </label> </div> <div class="ct-amount-container field radio 163848 required"> <label for="163848"> <input id="163848" name="donation-level" class="required" type="radio" value="1800.000000" maxlength="255"> <div class="ct-label-container"> <span class="label"><strong>$1,800</strong> Dedicate a Brick </span> </div> </label> </div> <div class="ct-amount-container field radio 163849 required"> <label for="163849"> <input id="163849" name="donation-level" class="required" type="radio" value="500 .000000" maxlength="255"> <div class="ct-label-container"> <span class="label"><strong>$500</strong> Dedicate Sanctuary Seat </span> </div> </label> </div> <div class="ct-amount-container field radio 163850 required"><label for="163850"> <input id="163850" name="donation-level" class="required" type="radio" value="300.000000" maxlength="255"> <div class="ct-label-container"> <span class="label"><strong>$300</strong> Dedicate Mezuzah </span> </div> </label> </div> <div class="ct-amount-container other-container"> <label for="other-option"> <input id="other-option" name="donation-level" class="required" type="radio" maxlength="255"> <div class="ct-label-container"> <div class="field radio other-option required"> <span class="label">General Building Fund Donation</span> </div> <div class="field text other-amount"> <input id="other-amount" name="other-amount" class="otherAmount" type="text" placeholder="$0.00"> </div> </div> </label> </div> </div> </div> <div class="ct-popup-trigger-button"> <button type="button" class="js-show-popup"> Donate </button> </div> </div> </div> </div> <div class="ct-popup-container js-popup"> <div class="ct-popup"> <div for="PopupShow" class="ct-popup-overlay js-hide-popup"> </div> <div class="ct-popup-contents"> <div class="errors hidden"></div> <div class="section contact"> <h3>Contact Information</h3> <div class="ct-fields-container"> <div class="ct-split-field"> <div class="field text first-name required"> <label for="first-name"> <span class="label">First Name</span><span class="required-star">*</span></label> <input id="first-name" name="first-name" class="required" type="text"> </div> <div class="field text last-name required"> <label for="last-name"> <span class="label">Last Name</span><span class="required-star">*</span></label> <input id="last-name" name="last-name" class="required" type="text"> </div> </div> <div class="field email email-address required"> <label for="email-address"> <span class="label">Email</span><span class="required-star">*</span></label> <input id="email-address" name="email-address" class="email required" type="email" placeholder=""> </div> <div class="field tel phone-number"> <label for="phone-number"> <span class="label">Phone</span></label> <input id="phone-number" name="phone-number" class="phoneUS" type="tel"> </div> </div> </div> <div class="section billing-address"> <h3>Billing Address</h3> <div class="ct-fields-container"> <div class="field country required select"> <label for="country">Country<span class="required-star">*</span></label> <select id="country" name="country" class="required"> <option value=""></option> <option value="AF">Afghanistan</option> <option value="AX">Aland Islands</option> <option value="AL">Albania</option> <option value="DZ">Algeria</option> <option value="AS">American Samoa</option> <option value="AD">Andorra</option> <option value="AO">Angola</option> <option value="AI">Anguilla</option> <option value="AQ">Antarctica</option> <option value="AG">Antigua and Barbuda</option> <option value="AR">Argentina</option> <option value="AM">Armenia</option> <option value="AW">Aruba</option> <option value="AU">Australia</option> <option value="AT">Austria</option> <option value="AZ">Azerbaijan</option> <option value="BS">Bahamas</option> <option value="BH">Bahrain</option> <option value="BD">Bangladesh</option> <option value="BB">Barbados</option> <option value="BY">Belarus</option> <option value="BE">Belgium</option> <option value="BZ">Belize</option> <option value="BJ">Benin</option> <option value="BM">Bermuda</option> <option value="BT">Bhutan</option> <option value="BO">Bolivia</option> <option value="BA">Bosnia and Herzegovina</option> <option value="BW">Botswana</option> <option value="BV">Bouvet Island</option> <option value="BR">Brazil</option> <option value="IO">British Indian Ocean Territory</option> <option value="BN">Brunei Darussalam</option> <option value="BG">Bulgaria</option> <option value="BF">Burkina Faso</option> <option value="BI">Burundi</option> <option value="KH">Cambodia</option> <option value="CM">Cameroon</option> <option value="CA">Canada</option> <option value="CV">Cape Verde</option> <option value="KY">Cayman Islands</option> <option value="CF">Central African Republic</option> <option value="TD">Chad</option> <option value="CL">Chile</option> <option value="CN">China</option> <option value="CX">Christmas Island</option> <option value="CC">Cocos (Keeling) Islands</option> <option value="CO">Colombia</option> <option value="KM">Comoros</option> <option value="CG">Congo</option> <option value="CD">Democratic Republic of the Congo</option> <option value="CK">Cook Islands</option> <option value="CR">Costa Rica</option> <option value="CI">Cote d'Ivoire</option> <option value="HR">Croatia</option> <option value="CU">Cuba</option> <option value="CW">Curacao</option> <option value="CY">Cyprus</option> <option value="CZ">Czech Republic</option> <option value="DK">Denmark</option> <option value="DJ">Djibouti</option> <option value="DM">Dominica</option> <option value="DO">Dominican Republic</option> <option value="EC">Ecuador</option> <option value="EG">Egypt</option> <option value="SV">El Salvador</option> <option value="GQ">Equatorial Guinea</option> <option value="ER">Eritrea</option> <option value="EE">Estonia</option> <option value="ET">Ethiopia</option> <option value="FK">Falkland Islands (Malvinas)</option> <option value="FO">Faroe Islands</option> <option value="FJ">Fiji</option> <option value="FI">Finland</option> <option value="FR">France</option> <option value="GF">French Guiana</option> <option value="PF">French Polynesia</option> <option value="TF">French Southern Territories</option> <option value="GA">Gabon</option> <option value="GM">Gambia</option> <option value="GE">Georgia</option> <option value="DE">Germany</option> <option value="GH">Ghana</option> <option value="GI">Gibraltar</option> <option value="GR">Greece</option> <option value="GL">Greenland</option> <option value="GD">Grenada</option> <option value="GP">Guadeloupe</option> <option value="GU">Guam</option> <option value="GT">Guatemala</option> <option value="GG">Guernsey</option> <option value="GN">Guinea</option> <option value="GW">Guinea-Bissau</option> <option value="GY">Guyana</option> <option value="HT">Haiti</option> <option value="HM">Heard Island</option> <option value="HN">Honduras</option> <option value="HK">Hong Kong</option> <option value="HU">Hungary</option> <option value="IS">Iceland</option> <option value="IN">India</option> <option value="ID">Indonesia</option> <option value="IR">Islamic Republic of Iran</option> <option value="IQ">Iraq</option> <option value="IE">Ireland</option> <option value="IM">Isle of Man</option> <option value="IL">Israel</option> <option value="IT">Italy</option> <option value="JM">Jamaica</option> <option value="JP">Japan</option> <option value="JE">Jersey</option> <option value="JO">Jordan</option> <option value="KZ">Kazakhstan</option> <option value="KE">Kenya</option> <option value="KI">Kiribati</option> <option value="KP">Democratic People's Republic of Korea</option> <option value="KR">Republic of Korea</option> <option value="KW">Kuwait</option> <option value="KG">Kyrgyzstan</option> <option value="LA">Lao People's Democratic Republic</option> <option value="LV">Latvia</option> <option value="LB">Lebanon</option> <option value="LS">Lesotho</option> <option value="LR">Liberia</option> <option value="LY">Libya</option> <option value="LI">Liechtenstein</option> <option value="LT">Lithuania</option> <option value="LU">Luxembourg</option> <option value="MO">Macao</option> <option value="MK">Macedonia</option> <option value="MG">Madagascar</option> <option value="MW">Malawi</option> <option value="MY">Malaysia</option> <option value="MV">Maldives</option> <option value="ML">Mali</option> <option value="MT">Malta</option> <option value="MH">Marshall Islands</option> <option value="MQ">Martinique</option> <option value="MR">Mauritania</option> <option value="MU">Mauritius</option> <option value="YT">Mayotte</option> <option value="MX">Mexico</option> <option value="FM">Federated States of Micronesia</option> <option value="MD">Republic of Moldova</option> <option value="MC">Monaco</option> <option value="MN">Mongolia</option> <option value="ME">Montenegro</option> <option value="MS">Montserrat</option> <option value="MA">Morocco</option> <option value="MZ">Mozambique</option> <option value="MM">Myanmar</option> <option value="NA">Namibia</option> <option value="NR">Nauru</option> <option value="NP">Nepal</option> <option value="NL">Netherlands</option> <option value="NC">New Caledonia</option> <option value="NZ">New Zealand</option> <option value="NI">Nicaragua</option> <option value="NE">Niger</option> <option value="NG">Nigeria</option> <option value="NU">Niue</option> <option value="NF">Norfolk Island</option> <option value="MP">Northern Mariana Islands</option> <option value="NO">Norway</option> <option value="OM">Oman</option> <option value="PK">Pakistan</option> <option value="PW">Palau</option> <option value="PA">Panama</option> <option value="PG">Papua New Guinea</option> <option value="PY">Paraguay</option> <option value="PE">Peru</option> <option value="PH">Philippines</option> <option value="PN">Pitcairn</option> <option value="PL">Poland</option> <option value="PT">Portugal</option> <option value="PR">Puerto Rico</option> <option value="QA">Qatar</option> <option value="RE">Reunion</option> <option value="RO">Romania</option> <option value="RU">Russian Federation</option> <option value="RW">Rwanda</option> <option value="BL">Saint Barthelemy</option> <option value="SH">Ascension and Tristan da Cunha Saint Helena</option> <option value="KN">Saint Kitts and Nevis</option> <option value="LC">Saint Lucia</option> <option value="MF">Saint Martin (French part)</option> <option value="PM">Saint Pierre and Miquelon</option> <option value="VC">Saint Vincent and the Grenadines</option> <option value="WS">Samoa</option> <option value="SM">San Marino</option> <option value="ST">Sao Tome and Principe</option> <option value="SA">Saudi Arabia</option> <option value="SN">Senegal</option> <option value="RS">Serbia</option> <option value="SC">Seychelles</option> <option value="SL">Sierra Leone</option> <option value="SG">Singapore</option> <option value="SX">Sint Maarten (Dutch part)</option> <option value="SK">Slovakia</option> <option value="SI">Slovenia</option> <option value="SB">Solomon Islands</option> <option value="SO">Somalia</option> <option value="ZA">South Africa</option> <option value="GS">South Georgia</option> <option value="SS">South Sudan</option> <option value="ES">Spain</option> <option value="LK">Sri Lanka</option> <option value="SD">Sudan</option> <option value="SR">Suriname</option> <option value="SJ">Svalbard and Jan Mayen</option> <option value="SZ">Swaziland</option> <option value="SE">Sweden</option> <option value="CH">Switzerland</option> <option value="SY">Syrian Arab Republic</option> <option value="TW">Taiwan</option> <option value="TJ">Tajikistan</option> <option value="TZ">United Republic of Tanzania</option> <option value="TH">Thailand</option> <option value="TL">Timor-Leste</option> <option value="TG">Togo</option> <option value="TK">Tokelau</option> <option value="TO">Tonga</option> <option value="TT">Trinidad and Tobago</option> <option value="TN">Tunisia</option> <option value="TR">Turkey</option> <option value="TM">Turkmenistan</option> <option value="TC">Turks and Caicos Islands</option> <option value="TV">Tuvalu</option> <option value="UG">Uganda</option> <option value="UA">Ukraine</option> <option value="AE">United Arab Emirates</option> <option value="GB">United Kingdom</option> <option value="US" selected>United States</option> <option value="UM">United States Minor Outlying Islands</option> <option value="UY">Uruguay</option> <option value="UZ">Uzbekistan</option> <option value="VU">Vanuatu</option> <option value="VA">Vatican City</option> <option value="VE">Venezuela</option> <option value="VN">Viet Nam</option> <option value="VG">British Virgin Islands</option> <option value="VI">U.S. Virgin Islands</option> <option value="WF">Wallis and Futuna</option> <option value="EH">Western Sahara</option> <option value="YE">Yemen</option> <option value="ZM">Zambia</option> <option value="ZW">Zimbabwe</option> </select> </div> <div class="field street-address required"> <label for="street-address"> <span class="label">Address</span><span class="required-star">*</span></label> <textarea id="street-address" name="street-address" class="required"></textarea> </div> <div class="ct-split-field"> <div class="field text city required"> <label for="city"> <span class="label">City</span><span class="required-star">*</span></label> <input id="city" name="city" class="required" type="text" data-us-label="City" data-bm-label="Parish"> </div> <div class="field state required select"> <label for="state">State<span class="required-star">*</span></label> <select id="state" name="state" class="required"> <option value=""></option> <option value="AL">Alabama</option> <option value="AK">Alaska</option> <option value="AS">American Samoa</option> <option value="AZ">Arizona</option> <option value="AR">Arkansas</option> <option value="AE">Armed Forces Africa, Canada, Europe, Middle East</option> <option value="AA">Armed Forces Americas (except Canada)</option> <option value="AP">Armed Forces Pacific</option> <option value="CA">California</option> <option value="CO">Colorado</option> <option value="CT">Connecticut</option> <option value="DE">Delaware</option> <option value="DC">District of Columbia</option> <option value="FL">Florida</option> <option value="GA">Georgia</option> <option value="GU">Guam</option> <option value="HI">Hawaii</option> <option value="ID">Idaho</option> <option value="IL">Illinois</option> <option value="IN">Indiana</option> <option value="IA">Iowa</option> <option value="KS">Kansas</option> <option value="KY">Kentucky</option> <option value="LA">Louisiana</option> <option value="ME">Maine</option> <option value="MD">Maryland</option> <option value="MA">Massachusetts</option> <option value="MI">Michigan</option> <option value="MN">Minnesota</option> <option value="MS">Mississippi</option> <option value="MO">Missouri</option> <option value="MT">Montana</option> <option value="NE">Nebraska</option> <option value="NV">Nevada</option> <option value="NH">New Hampshire</option> <option value="NJ">New Jersey</option> <option value="NM">New Mexico</option> <option value="NY">New York</option> <option value="NC">North Carolina</option> <option value="ND">North Dakota</option> <option value="OH">Ohio</option> <option value="OK">Oklahoma</option> <option value="OR">Oregon</option> <option value="PA">Pennsylvania</option> <option value="PR">Puerto Rico</option> <option value="RI">Rhode Island</option> <option value="SC">South Carolina</option> <option value="SD">South Dakota</option> <option value="TN">Tennessee</option> <option value="TX">Texas</option> <option value="VI">US Virgin Islands</option> <option value="UT">Utah</option> <option value="VT">Vermont</option> <option value="VA">Virginia</option> <option value="WA">Washington</option> <option value="WV">West Virginia</option> <option value="WI">Wisconsin</option> <option value="WY">Wyoming</option> </select> </div> <div class="field province required select" style="display: none"> <label for="province">Province<span class="required-star">*</span></label> <select id="province" name="province" class="required"> <option value=""></option> <option value="AB">Alberta</option> <option value="BC">British Columbia</option> <option value="MB">Manitoba</option> <option value="NB">New Brunswick</option> <option value="NL">Newfoundland and Labrador</option> <option value="NT">Northwest Territories</option> <option value="NS">Nova Scotia</option> <option value="NU">Nunavut</option> <option value="ON">Ontario</option> <option value="PE">Prince Edward Island</option> <option value="QC">Quebec</option> <option value="SK">Saskatchewan</option> <option value="YT">Yukon Territory</option> </select> </div> <div class="field number zip-code required"> <label for="zip-code"> <span class="label">ZIP Code</span><span class="required-star">*</span></label> <input id="zip-code" name="zip-code" class="zipcodeUS required" type="number" minlength="5" maxlength="10"> </div> <div class="field text postal-code required" style="display: none"> <label for="postal-code"> <span class="label">Postal Code</span><span class="required-star">*</span></label> <input id="postal-code" name="postal-code" class="required" type="text"> </div> </div> </div> </div> <div class="section custom-fields"> <h3>Additional Information</h3> <div class="ct-fields-container"> <div class="field text CustomTransactionField_174081"> <label for="CustomTransactionField_174081"> <span class="label">Donation in memory or in honor of....</span></label> <input id="CustomTransactionField_174081" name="CustomTransactionField_174081" type="text" maxlength="255"> </div> <div class="field text comment"> <label for="comment"> <span class="label">Comments</span></label> <textarea id="comment" name="comment" type="text" value="Comments"></textarea> </div> </div> </div> <div class="section recurring"> <div class="ct-fields-container"> <div class="field checkbox recurring"> <label for="recurring"> <input id="recurring" name="recurring" type="checkbox" maxlength="255"> <span class="label">Show my support by making this a recurring donation</span></label> </div> <div class="field frequency required select" style="display: none"> <label for="frequency">Frequency<span class="required-star">*</span></label> <select id="frequency" name="frequency" class="required"> <option value=""></option> <option value="Weekly">Weekly</option> <option value="Monthly" selected>Monthly</option> <option value="Quarterly">Quarterly</option> <option value="Yearly">Yearly</option> </select> </div> <div class="field date start-date required" style="display: none"> <label for="start-date"> <span class="label">Start Date</span><span class="required-star">*</span></label> <input id="start-date" name="start-date" class="validDate required" type="date" placeholder="mm/dd/yyyy"> </div> </div> </div> <div class="section consent hidden"> <div class="ct-fields-container"> <div class="field checkbox consent-all"> <label for="consent-all"> <input id="consent-all" name="consent-all" type="checkbox" maxlength="255"> <span class="label">I would like to receive or continue receiving updates from Chabad of Charlotte</span></label> </div> <div class="field checkbox consent-email" style="display: none"> <label for="consent-email"> <input id="consent-email" name="consent-email" type="checkbox" checked maxlength="255"> <span class="label">by email</span></label> </div> <div class="field checkbox consent-mail" style="display: none"> <label for="consent-mail"> <input id="consent-mail" name="consent-mail" type="checkbox" checked maxlength="255"> <span class="label">by postal mail</span></label> </div> <div class="field checkbox consent-phone" style="display: none"> <label for="consent-phone"> <input id="consent-phone" name="consent-phone" type="checkbox" checked maxlength="255"> <span class="label">by phone</span></label> </div> </div> </div> <div class="section captcha"> <label id="noCaptchaResponseError" class="error noCaptchaResponseError" style="display: none">You must fill out the CAPTCHA</label> <div id="captcha161792"></div> </div> <div class="btn-group"> <input class="btn btn-submit btn-submit-donation" type="submit" value="Enter Payment" id="express-submit" disabled> </div> <div class="ct-popup-close js-hide-popup"> </div> </div> </div> </div> </form> </div> <div id="donation-processing-container" style="display: none"> <section><h2>Processing...</h2> <p>Your transaction is being processed. Please do not close your browser or leave this page.</p> </section></div>
