<form id="90297027622154" accept-charset="utf-8" action="https://submit.jotform.us/submit/90297027622154/" autocomplete="on" method="post" name="form_90297027622154" novalidate="true"><input name="formID" type="hidden" value="90297027622154" /> <input id="JWTContainer" type="hidden" value="" /> <input id="cardinalOrderNumber" type="hidden" value="" />
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<li id="id_3" data-type="control_text">
<p style="text-align: justify;">The Scottish Collie Preservation Society (SCPS) is a Non profit 501c3 organization of concerned breeders, owners, and individuals who are dedicated to preserving the original Scottish Collie as defined in the 1885 to 1910 Collie Standards. By providing necessary tools and information through the Breeding Certification Program, the SCPS will be able to ensure the reliable temperament, genetic diversity, and the health of the classic Collie and thereby secure the future of the Scottish Collie breed.</p>
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<li id="cid_1" data-type="control_head">
<h2 id="header_1" data-component="header">One Time Donation</h2>
Help support the Preservation of the Scottish Collie
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<li id="id_4" data-type="control_fullname"><label id="label_4" for="first_4"> Name </label>
 <input id="first_4" name="q4_name[first]" size="10" type="text" value="" data-defaultvalue="" data-component="first" aria-labelledby="label_4 sublabel_4_first" /> <label id="sublabel_4_first" style="min-height: 13px;" for="first_4" aria-hidden="false"> First Name </label>   <input id="last_4" name="q4_name[last]" size="15" type="text" value="" data-defaultvalue="" data-component="last" aria-labelledby="label_4 sublabel_4_last" /> <label id="sublabel_4_last" style="min-height: 13px;" for="last_4" aria-hidden="false"> Last Name </label> 
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<li id="id_5" data-type="control_address"><label id="label_5" for="input_5_addr_line1"> Address </label>
  <input id="input_5_addr_line1" name="q5_address[addr_line1]" type="text" value="" data-defaultvalue="" data-component="address_line_1" aria-labelledby="label_5 sublabel_5_addr_line1" /> <label id="sublabel_5_addr_line1" style="min-height: 13px;" for="input_5_addr_line1" aria-hidden="false"> Street Address </label>  
  <input id="input_5_addr_line2" name="q5_address[addr_line2]" type="text" value="" data-defaultvalue="" data-component="address_line_2" aria-labelledby="label_5 sublabel_5_addr_line2" /> <label id="sublabel_5_addr_line2" style="min-height: 13px;" for="input_5_addr_line2" aria-hidden="false"> Street Address Line 2 </label>  
  <input id="input_5_city" name="q5_address[city]" type="text" value="" data-defaultvalue="" data-component="city" aria-labelledby="label_5 sublabel_5_city" /> <label id="sublabel_5_city" style="min-height: 13px;" for="input_5_city" aria-hidden="false"> City </label>     <input id="input_5_state" name="q5_address[state]" type="text" value="" data-defaultvalue="" data-component="state" aria-labelledby="label_5 sublabel_5_state" /> <label id="sublabel_5_state" style="min-height: 13px;" for="input_5_state" aria-hidden="false"> State / Province </label>  
  <input id="input_5_postal" name="q5_address[postal]" type="text" value="" data-defaultvalue="" data-component="zip" aria-labelledby="label_5 sublabel_5_postal" /> <label id="sublabel_5_postal" style="min-height: 13px;" for="input_5_postal" aria-hidden="false"> Postal / Zip Code </label>  
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<li id="id_6" data-type="control_email"><label id="label_6" for="input_6"> Email </label>
 <input id="input_6" name="q6_email" size="30" type="email" value="" data-defaultvalue="" data-component="email" aria-labelledby="label_6 sublabel_input_6" /> <label id="sublabel_input_6" style="min-height: 13px;" for="input_6" aria-hidden="false"> example@example.com </label> 
</li>
<li id="id_7" data-type="control_phone"><label id="label_7" for="input_7_area"> Phone Number </label>
 <input id="input_7_area" name="q7_phoneNumber[area]" type="tel" value="" data-defaultvalue="" data-component="areaCode" aria-labelledby="label_7 sublabel_7_area" />   -  <label id="sublabel_7_area" style="min-height: 13px;" for="input_7_area" aria-hidden="false"> Area Code </label>   <input id="input_7_phone" name="q7_phoneNumber[phone]" type="tel" value="" data-defaultvalue="" data-component="phone" aria-labelledby="label_7 sublabel_7_phone" /> <label id="sublabel_7_phone" style="min-height: 13px;" for="input_7_phone" aria-hidden="false"> Phone Number </label> 
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<li id="id_8" data-type="control_stripe" data-payment="true"><label id="label_8" for="input_8"> DONATE TODAY </label>
 
<input name="simple_fpc" type="hidden" value="8" data-payment_type="stripe" data-component="payment1" /> <input id="payment_total_checksum" name="payment_total_checksum" type="hidden" data-component="payment2" />
<img id="current-image" />  prev   next   ( X ) 
 <img style="height: auto; vertical-align: middle;" src="https://www.jotform.com/uploads/scottishcollieps/form_files/pizap.com15488934527281.5c5244c810b096.33308956.jpg" alt="product" width="50" />
<input id="input_8_1000" name="q8_myProducts[][id]" type="checkbox" value="1000" /> <label for="input_8_1000">  Donate Now   <b> $  10.00  </b>  </label>
<br /> <img style="height: auto; vertical-align: middle;" src="https://www.jotform.com/uploads/scottishcollieps/form_files/pizap.com15488934527281.5c5245563daee6.90702652.jpg" alt="product" width="50" />
<input id="input_8_1001" name="q8_myProducts[][id]" type="checkbox" value="1001" /> <label for="input_8_1001">  Donate Now   <b> $  25.00  </b>  </label>
<br /> <img style="height: auto; vertical-align: middle;" src="https://www.jotform.com/uploads/scottishcollieps/form_files/pizap.com15488934527281.5c524597e24308.79045522.jpg" alt="product" width="50" />
<input id="input_8_1002" name="q8_myProducts[][id]" type="checkbox" value="1002" /> <label for="input_8_1002">  Donate Now   <b> $  50.00  </b>  </label>
<br /> <img style="height: auto; vertical-align: middle;" src="https://www.jotform.com/uploads/scottishcollieps/form_files/pizap.com15488934527281.5c52463837eef9.66882769.jpg" alt="product" width="50" />
<input id="input_8_1003" name="q8_myProducts[][id]" type="checkbox" value="1003" /> <label for="input_8_1003">  Donate Now   <b> $  75.00  </b>  </label>
<br /> <img style="height: auto; vertical-align: middle;" src="https://www.jotform.com/uploads/scottishcollieps/form_files/pizap.com15488934527281.5c5246818bb0c4.67672275.jpg" alt="product" width="50" />
<input id="input_8_1004" name="q8_myProducts[][id]" type="checkbox" value="1004" /> <label for="input_8_1004">  Donate Now   <b> $  100.00  </b>  </label>
<br /> <img style="height: auto; vertical-align: middle;" src="https://www.jotform.com/uploads/scottishcollieps/form_files/pizap.com15488934527281.5c5246d5eb2ad9.26606784.jpg" alt="product" width="50" />
<input id="input_8_1005" name="q8_myProducts[][id]" type="checkbox" value="1005" /> <label for="input_8_1005">  Donate Now   <b> $  250.00  </b>  </label>
<br /> <b> Total    $ 0.00  </b> 
<hr />
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<th id="ccTitle8" style="text-align: left;" colspan="2">Credit Card Details</th>
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<td width="50%">
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<label id="sublabel_cc_number" style="min-height: 13px; margin: 0 0 3px 0;" for="input_8_cc_number" aria-hidden="false"> Credit Card Number </label> </td>
<td width="50%">
<iframe style="border: none !important; margin: 0px !important; padding: 0px !important; width: 1px !important; min-width: 100% !important; overflow: hidden !important; display: block !important; user-select: none !important; transform: translate(0px) !important; height: 16.8px;" title="Secure CVC input frame" src="https://js.stripe.com/v3/elements-inner-card-0d05756b439a8445867076ee64aa9194.html#wait=false&amp;mids[guid]=NA&amp;mids[muid]=NA&amp;mids[sid]=NA&amp;style[base][fontFamily]=roboto%2C+sans-serif&amp;rtl=false&amp;componentName=cardCvc&amp;keyMode=live&amp;apiKey=pk_live_ihnYbqyALabqjS0CxMWU78L0&amp;referrer=https%3A%2F%2Fform.jotform.com%2F90297027622154&amp;controllerId=__privateStripeController7191" name="__privateStripeFrame7196" frameborder="0" scrolling="no"></iframe><input style="border: none !important; display: block !important; position: absolute !important; height: 1px !important; top: -1px !important; left: 0px !important; padding: 0px !important; margin: 0px !important; width: 100% !important; opacity: 0 !important; background: transparent !important; pointer-events: none !important; font-size: 16px !important;" autocomplete="false" maxlength="1" type="text" aria-hidden="true" aria-label=" " />
<label id="sublabel_cc_ccv" style="min-height: 13px; margin: 0 0 3px 0;" for="input_8_cc_ccv" aria-hidden="false"> Security Code </label> </td>
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<tr>
<td width="50%">
<iframe style="border: none !important; margin: 0px !important; padding: 0px !important; width: 1px !important; min-width: 100% !important; overflow: hidden !important; display: block !important; user-select: none !important; transform: translate(0px) !important; height: 16.8px;" title="Secure expiration date input frame" src="https://js.stripe.com/v3/elements-inner-card-0d05756b439a8445867076ee64aa9194.html#wait=false&amp;mids[guid]=NA&amp;mids[muid]=NA&amp;mids[sid]=NA&amp;style[base][fontFamily]=roboto%2C+sans-serif&amp;rtl=false&amp;componentName=cardExpiry&amp;keyMode=live&amp;apiKey=pk_live_ihnYbqyALabqjS0CxMWU78L0&amp;referrer=https%3A%2F%2Fform.jotform.com%2F90297027622154&amp;controllerId=__privateStripeController7191" name="__privateStripeFrame7197" frameborder="0" scrolling="no"></iframe><input style="border: none !important; display: block !important; position: absolute !important; height: 1px !important; top: -1px !important; left: 0px !important; padding: 0px !important; margin: 0px !important; width: 100% !important; opacity: 0 !important; background: transparent !important; pointer-events: none !important; font-size: 16px !important;" autocomplete="false" maxlength="1" type="text" aria-hidden="true" aria-label=" " />
<label id="sublabel_cc_card_expiry" style="min-height: 13px; margin: 0 0 3px 0;" for="input_8_cc_card_expiry" aria-hidden="false"> Card Expiration </label> </td>
<td width="50%"> </td>
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<tr style="display: none;">
<td><input id="stripesca_dummy" style="display: none;" type="text" /></td>
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<li id="id_9" data-type="control_radio"><label id="label_9" for="input_9"> We are a Registered Non-Profit 501C3 Organization. Would you like a receipt emailed to you for your donation today? </label>
 <input id="input_9_0" name="q9_weAre9" type="radio" value="YES" aria-describedby="label_9" /> <label id="label_input_9_0" for="input_9_0"> YES </label>   <input id="input_9_1" name="q9_weAre9" type="radio" value="NO" aria-describedby="label_9" /> <label id="label_input_9_1" for="input_9_1"> NO </label> 
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<button id="input_2" type="submit" data-component="button" data-content=""> Submit </button> <br /><a style="display: inline-block; text-decoration: none; opacity: 0.8; -webkit-font-smoothing: antialiased; color: #000000; font-family: 'Lucida Grande', sans-serif; font-size: 11px; margin-left: -11.125px;" href="https://www.jotform.com/?utm_source=powered_by_jotform&amp;utm_medium=banner&amp;utm_term=90297027622154&amp;utm_content=powered_by_jotform_text&amp;utm_campaign=powered_by_jotform_signup_hp" target="_blank" rel="noopener">Powered by Jotform</a>
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<li style="display: none;">Should be Empty: <input name="website" type="text" value="" /></li>
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