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<title> Donor Form</title>
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<FORM ACTION="/donation_form_.php" name="payment_form" method="post" onSubmit="return CheckForm()">
<table border="0" width="100%" cellspacing="2" cellpadding="2">
<input type=hidden name=command value=thanks>
<P><INPUT type=radio value="I am an individual donor." name=donor_type>I am an individual donor.<BR><INPUT type=radio value="I am making a corporate contribution." name=donor_type>I am making a corporate contribution.</P>
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<P>Company Name </P></TD>
<TD><input type="text" name="company_name" size="20" STYLE="width: 250px" value=""></TD></TR>
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</SELECT></P></TD></TR>
<tr><td>Position </TD>
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<P><INPUT name=position type=text STYLE="width: 250px"></P></TD></TR>
<TR><TD>First Name<font color=#ff0000></font></TD>
<TD><input type="text" name="first_name" size="20" STYLE="width: 250px" value=""></TD></TR>
<TR><TD>Last Name<font color=#ff0000></font></TD>
<TD><input type="text" name="last_name" size="20" STYLE="width: 250px" value=""></TD></TR>
<TR><TD>Email Address<font color=#ff0000></font></TD>
<TD><input type="text" name="email" size="20" STYLE="width: 250px" value=""></TD></TR>
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<P><INPUT type=checkbox value=1 name=remain_anonymous> I would like my contribution to remain anonymous.</P></TD></TR>
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<form id="donate" action="https://www.paypal.com/cgi-bin/webscr" method="post">
<p> Donate (via PayPal):<br><input type="radio" name="amount" value="100.00" checked="checked" />
$100 And receive a complimentary T-shirt with the drunken penguin design!<br>
<input type="radio" name="amount" value="500.00" />
$500 And receive A listing in the 'thank you' box located on the front page of Winehq.org until after the next Wine conference.<br>
<input type="radio" name="amount" value="" />
other<br>
<input name="submit" type="submit" class="button" value="Donate!" />
<input type="hidden" name="cmd" value="_xclick" />
<input type="hidden" name="business" value="donate@winehq.org" />
<input type="hidden" name="item_name" value="Wine donation" />
<input type="hidden" name="no_shipping" value="1" />
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<p>If not PayPal, please send a check or money order to:</p>
<p>
<strong>
The Wine Party Fund<br/>
c/o Jeremy White<br/>
CodeWeavers<br/>
2356 University Ave. West<br/>
Suite 420<br/>
St. Paul, MN 55114
</strong>
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