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Account Information
First Name
*
Enter First Name
Last Name
*
Enter Last Name
Charity Name
*
Enter Company Name
Email
*
Enter Email Address~*Enter valid email address
Address Line 1
*
Enter Address1
Address Line 2
Website URL
Enter valid url
City
*
Enter City Name
Province / State
*
Select
Select a State from the list
Enter Province
Postal Code / Zip
*
Enter Postal Code/Zip
Phone Number
*
Enter Phone Number
Fax
About Charity
(This text will be shown in the charity page)
Logo
Maximum File Size :1.5MB
File Types :jpg,png,jpeg,gif
Banner
*
Maximum File Size :1.5MB
File Types :jpg,png,jpeg,gif
Please upload valid image
Suggested Dimension : 705 * 350
(Banner image will be shown in the charity page)
Payable Account Information
Account Type
*
Paypal
Check
Select Account Type
FirstName
*
Make check payable to
*
Enter Paypal FirstName
Enter Check payable to
LastName
*
Enter Paypal LastName
Paypal Email
*
Enter Paypal Business Email
Create Paypal Account?
Security code
*
Enter security code~*Invalid Security Code
(case sensitive)
I Agree to the
Charity Terms And Conditions
You must agree to our terms and conditions
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