Template:DonationForm/Monthly/CAD
<html>
<form class="contrib" action="https://www.paypal.com/</html>{{{PayPalLang}}}<html>cgi-bin/webscr" method="post"> <input type="hidden" name="business" value="donation@wikipedia.org" /> <input type="hidden" name="item_name" value="</html>{{{MonthlyDonation}}}<html>" /> <input type="hidden" name="item_number" value="DONATE" /> <input type="hidden" name="no_note" value="0" /> <input type="hidden" name="currency_code" value="CAD" /> </html>{{{SupportLevel}}}<html>
<select name="a3"> <option value="7" selected="selected"></html>{{{Tier}}} 1 ($7/{{{month}}})<html></option> <option value="15"></html>{{{Tier}}} 2 ($15/{{{month}}})<html></option> <option value="25"></html>{{{Tier}}} 3 ($25/{{{month}}})<html> </option> <option value="45"></html>{{{Tier}}} 4 ($45/{{{month}}})<html> </option> <option value="65"></html>{{{Tier}}} 5 ($65/{{{month}}})<html> </option> <option value="130"></html>{{{Tier}}} 6 ($130/{{{month}}})<html> </option> </select> <input type="hidden" name="cmd" value="_xclick-subscriptions" /> <input type="hidden" name="p3" value="1" /> <input type="hidden" name="t3" value="M" /> <input type="hidden" name="src" value="1" /> <input type="hidden" name="sra" value="1" /> <input type="hidden" name="on0" value="Comment" /> <input type="hidden" name="on1" value="Anonymity" />
</html>{{{ShortComment}}}<html>*
<input type="text" name="os0" maxlength="200" />
</html>{{{MentionName}}}<html>*
<input type="radio" name="os1" value="Mention my name"></html>{{{Yes}}}<html> <input type="radio" name="os1" value="Don't mention my name"></html>{{{No}}}<html>
</html>{{{IfNo}}}<html>
*</html>{{{Optional}}}<html>
<input class="centered" type="submit" value="</html>{{{Submit}}}<html>" /> </form>
</html>