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			<h1 class="article-header__title js-article-title js-page-title">TEST form</h1>
		
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    <ul class="form-section">
      <li id="cid_9" class="form-input-wide">
        <div class="form-header-group">
          <h2 id="header_9" class="form-header">
            Please donate to Chabad today!
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      <li class="form-line" id="id_12">
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              Thanks for being a part of Chabad and sharing in our vision. Your donation enables us to offer an array of local programming throughout the year!
            </p>
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            Full Name<span class="form-required">*</span>
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                    <option value="Comoros"> Comoros </option>
                    <option value="Congo"> Congo </option>
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                    <option value="Cote d'Ivoire"> Cote d'Ivoire </option>
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                    <option value="Saint Pierre and Miquelon"> Saint Pierre and Miquelon </option>
                    <option value="Saint Vincent and the Grenadines"> Saint Vincent and the Grenadines </option>
                    <option value="Samoa"> Samoa </option>
                    <option value="San Marino"> San Marino </option>
                    <option value="Sao Tome and Principe"> Sao Tome and Principe </option>
                    <option value="Saudi Arabia"> Saudi Arabia </option>
                    <option value="Senegal"> Senegal </option>
                    <option value="Serbia"> Serbia </option>
                    <option value="Seychelles"> Seychelles </option>
                    <option value="Sierra Leone"> Sierra Leone </option>
                    <option value="Singapore"> Singapore </option>
                    <option value="Slovakia"> Slovakia </option>
                    <option value="Slovenia"> Slovenia </option>
                    <option value="Solomon Islands"> Solomon Islands </option>
                    <option value="Somalia"> Somalia </option>
                    <option value="Somaliland"> Somaliland </option>
                    <option value="South Africa"> South Africa </option>
                    <option value="South Ossetia"> South Ossetia </option>
                    <option value="Spain"> Spain </option>
                    <option value="Sri Lanka"> Sri Lanka </option>
                    <option value="Sudan"> Sudan </option>
                    <option value="Suriname"> Suriname </option>
                    <option value="Svalbard"> Svalbard </option>
                    <option value="Swaziland"> Swaziland </option>
                    <option value="Sweden"> Sweden </option>
                    <option value="Switzerland"> Switzerland </option>
                    <option value="Syria"> Syria </option>
                    <option value="Taiwan"> Taiwan </option>
                    <option value="Tajikistan"> Tajikistan </option>
                    <option value="Tanzania"> Tanzania </option>
                    <option value="Thailand"> Thailand </option>
                    <option value="Timor-Leste"> Timor-Leste </option>
                    <option value="Togo"> Togo </option>
                    <option value="Tokelau"> Tokelau </option>
                    <option value="Tonga"> Tonga </option>
                    <option value="Transnistria Pridnestrovie"> Transnistria Pridnestrovie </option>
                    <option value="Trinidad and Tobago"> Trinidad and Tobago </option>
                    <option value="Tristan da Cunha"> Tristan da Cunha </option>
                    <option value="Tunisia"> Tunisia </option>
                    <option value="Turkey"> Turkey </option>
                    <option value="Turkmenistan"> Turkmenistan </option>
                    <option value="Turks and Caicos Islands"> Turks and Caicos Islands </option>
                    <option value="Tuvalu"> Tuvalu </option>
                    <option value="Uganda"> Uganda </option>
                    <option value="Ukraine"> Ukraine </option>
                    <option value="United Arab Emirates"> United Arab Emirates </option>
                    <option value="United Kingdom"> United Kingdom </option>
                    <option value="Uruguay"> Uruguay </option>
                    <option value="Uzbekistan"> Uzbekistan </option>
                    <option value="Vanuatu"> Vanuatu </option>
                    <option value="Vatican City"> Vatican City </option>
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                    <option value="Western Sahara"> Western Sahara </option>
                    <option value="Yemen"> Yemen </option>
                    <option value="Zambia"> Zambia </option>
                    <option value="Zimbabwe"> Zimbabwe </option>
                    <option value="other"> Other </option>
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                  <label class="form-sub-label" for="input_10_country" id="sublabel_10_country"> Country </label></span>
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              <label class="form-sub-label" for="input_6_phone" id="sublabel_phone"> Phone Number </label></span>
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          <label class="label-message" for="input_8">  </label>
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              </label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_8_1" name="q8_amount" value="36" />
              <label for="input_8_1"><span>$36</span>
              </label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_8_2" name="q8_amount" value="100" />
              <label for="input_8_2"><span>$100</span>
              </label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_8_3" name="q8_amount" value="180" />
              <label for="input_8_3"><span>$180</span>
              </label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_8_4" name="q8_amount" value="360" />
              <label for="input_8_4"><span>$360</span>
              </label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio validate[required]" id="input_8_5" name="q8_amount" value="770" />
              <label for="input_8_5"><span>$770</span>
              </label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_8_6" name="q8_amount" value="1018" />
              <label for="input_8_6"><span>$1018</span>
              </label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio-other form-radio validate[required]" name="q8_amount" id="other_8" value="" /><span><input type="number" class="form-radio-other-input form-textbox" onkeypress="validateNumber(event)" name="q8_amount[other]" data-otherhint="Other" size="15" id="input_8" disabled="disabled" /></span>
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                          <option value="Mastercard"> MasterCard </option>
                          <option value="Amex"> American Express </option>
                          <option value="Discover"> Discover </option>
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                    <td colspan="2" class="cc_name_on_card "><span class="form-sub-label-container"><input class="form-textbox validate[required, visible]" type="text" name="q7_payment7[cc_nameOnCard]" id="input_7_cc_nameOnCard" size="33" autocomplete="off" />
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                          <option>  </option>
                          <option value="1"> 1 - January </option>
                          <option value="2"> 2 - February </option>
                          <option value="3"> 3 - March </option>
                          <option value="4"> 4 - April </option>
                          <option value="5"> 5 - May </option>
                          <option value="6"> 6 - June </option>
                          <option value="7"> 7 - July </option>
                          <option value="8"> 8 - August </option>
                          <option value="9"> 9 - September </option>
                          <option value="10"> 10 - October </option>
                          <option value="11"> 11 - November </option>
                          <option value="12"> 12 - December </option>
                        </select>
                        <label class="form-sub-label" for="input_7_cc_exp_month" id="sublabel_cc_exp_month"> Expiration Month </label></span>
                    </td>
                    <td><span class="form-sub-label-container"><select class="form-textbox validate[required, visible]" name="q7_payment7[cc_exp_year]" id="input_7_cc_exp_year">
                          <option>  </option>
                          <option value="2018"> 2018 </option>
                          <option value="2019"> 2019 </option>
                          <option value="2020"> 2020 </option>
                          <option value="2021"> 2021 </option>
                          <option value="2022"> 2022 </option>
                          <option value="2023"> 2023 </option>
                          <option value="2024"> 2024 </option>
                          <option value="2025"> 2025 </option>
                          <option value="2026"> 2026 </option>
                          <option value="2027"> 2027 </option>
                        </select>
                        <label class="form-sub-label" for="input_7_cc_exp_year" id="sublabel_cc_exp_year"> Expiration Year </label></span>
                    </td>
                  </tr>
                </tbody></table>
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              <td colspan="2">
                Paypal has been selected. Payment will take place on the next page.
              </td>
            </tr>
            <tr class="other hide">
              <td colspan="2">
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              </td>
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            <option value="2"> 2 </option>
            <option value="3"> 3 </option>
            <option value="4"> 4 </option>
            <option value="5"> 5 </option>
            <option value="6"> 6 </option>
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            <option value="Option 3"> Option 3 </option>
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