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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> <html xmlns="http://www.w3.org/1999/xhtml"> <head> <meta name="Description" content="In Vest USA is a not-for-profit organization whose sole mission is to make sure our law enforcement officers are protected with bullet-proof vests." /> <html xmlns="http://www.w3.org/1999/xhtml"> <script src="../Scripts/AC_ActiveX.js" type="text/javascript"></script> <script src="../Scripts/AC_RunActiveContent.js" type="text/javascript"></script> <script type="text/javascript"> <!-- function MM_findObj(n, d) { //v4.01 var p,i,x; if(!d) d=document; if((p=n.indexOf("?"))>0&&parent.frames.length) { d=parent.frames[n.substring(p+1)].document; n=n.substring(0,p);} if(!(x=d[n])&&d.all) x=d.all[n]; for (i=0;!x&&i<d.forms.length;i++) x=d.forms[i][n]; for(i=0;!x&&d.layers&&i<d.layers.length;i++) x=MM_findObj(n,d.layers[i].document); if(!x && d.getElementById) x=d.getElementById(n); return x; 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In-Vest USA, InVestUSA, Police officer vests, police vests" /> <link href="investstyles.css" rel="stylesheet" type="text/css" /> <script type="text/javascript"> <!-- function MM_preloadImages() { //v3.0 var d=document; if(d.images){ if(!d.MM_p) d.MM_p=new Array(); var i,j=d.MM_p.length,a=MM_preloadImages.arguments; for(i=0; i<a.length; i++) if (a[i].indexOf("#")!=0){ d.MM_p[j]=new Image; d.MM_p[j++].src=a[i];}} } //--> </script> </head> <body onload="MM_preloadImages('images/investnavbar_r2_c1_f3.gif','images/investnavbar_r2_c1_f2.gif','images/investnavbar_r2_c2_f3.gif','images/investnavbar_r2_c2_f2.gif','images/investnavbar_r2_c3_f3.gif','images/investnavbar_r2_c3_f2.gif','images/investnavbar_r2_c4_f3.gif','images/investnavbar_r2_c4_f2.gif','images/investnavbar_r2_c6_f3.gif','images/investnavbar_r2_c6_f2.gif','images/investnavbar_r2_c7_f3.gif','images/investnavbar_r2_c7_f2.gif','images/investnavbar_r2_c8_f3.gif','images/investnavbar_r2_c8_f2.gif','images/investnavbar_r2_c9_f3.gif','images/investnavbar_r2_c9_f2.gif','images/investnavbar_r2_c8.gif')"> <table width="800" border="0" align="center" cellpadding="0" cellspacing="0"> <!-- fwtable fwsrc="investnavbar.png" fwpage="Page 1" fwbase="investnavbar.gif" fwstyle="Dreamweaver" fwdocid = "1444938451" fwnested="0" --> <tr> <td colspan="9"><img name="investnavbar_r1_c1" src="images/investnavbar_r1_c1.gif" width="800" height="124" border="0" id="investnavbar_r1_c1" alt="" 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onclick="MM_nbGroup('down','navbar1','investnavbar_r2_c8','images/investnavbar_r2_c8_f3.gif',1);" onmouseover="MM_nbGroup('over','investnavbar_r2_c8','images/investnavbar_r2_c8_f2.gif','images/investnavbar_r2_c8_f3.gif',1);" onmouseout="MM_nbGroup('out');"><img src="images/investnavbar_r2_c8_f3.gif" alt="Get Involved with In-Vest USA" name="investnavbar_r2_c8" border="0" id="investnavbar_r2_c8" onload="MM_nbGroup('init','navbar1','investnavbar_r2_c8','images/investnavbar_r2_c8.gif',1)" /></a></td> <td><a href="contact.html" target="_top" onclick="MM_nbGroup('down','navbar1','investnavbar_r2_c9','images/investnavbar_r2_c9_f3.gif',1);" onmouseover="MM_nbGroup('over','investnavbar_r2_c9','images/investnavbar_r2_c9_f2.gif','images/investnavbar_r2_c9_f3.gif',1);" onmouseout="MM_nbGroup('out');"><img name="investnavbar_r2_c9" src="images/investnavbar_r2_c9.gif" width="77" height="21" border="0" id="investnavbar_r2_c9" alt="Contact In-Vest USA" /></a></td> </tr> </table> <table width="800" border="0" align="center" cellpadding="10" cellspacing="0" bordercolor="0" bgcolor="#FFFFFF"> <tr> <td valign="top"><p align="left" class="heads4invest">In-Vest USA Donations </p> <p>Please fill out this simple form to make your tax-deductible contribution to In-VestUSA. All transactions take place on the most secure server technology available. If you prefer, you can print this form and mail it to: In-VestUSA, P.O. Box 23489, Columbia, S.C. 29224-3489. <br /> If you have any questions, please contact <a href="mailto:donations@investusa.org">donations@investusa.org</a>.</p> <form method="post" action="http://www.customericity.com/investusa.org/formmail.php" name="DonationForm"> <input type="hidden" name="env_report" value="REMOTE_HOST,REMOTE_ADDR,HTTP_USER_AGENT,AUTH_TYPE,REMOTE_USER"> <!-- STEP 2: Put your email address in the 'recipients' value. Note that you also have to allow this email address in the $TARGET_EMAIL setting within formmail.php! --> <input type="hidden" name="recipients" value="pfournier@customericity.com" /> <!-- STEP 3: Specify required fields in the 'required' value --> <input type="hidden" name="required" value="firstname,lastname,address_line_1,city,state,zip,email,amount,card_type,cc_number,security_code,cardexpmonth,cardexpyear" /> <!-- STEP 4: Put your subject line in the 'subject' value. --> <input type="hidden" name="subject" value="Donation Form" /> <input type="hidden" name="good_url" value="thankyou.html" /> <input type="hidden" name="derive_fields" value="realname=firstname+lastname" /> <input type="hidden" name="mail_options" value="Exclude=realname;Submit;cc_number;security_code;cardexpmonth;cardexpyear,NoEmpty" /> <input type="hidden" name="csvfile" value="donationscsv/formmail.csv" /> <input type="hidden" name="csvcolumns" value="email,firstname,lastname,address_line_1,address_line_2,city,state,zip,card_type,cc_number,security_code,cardexpmonth,cardexpyear" /> <table width="650" border="0" align="center" cellpadding="3"> <tr> <td width="50%" align="right" valign="top"><p><span class="pred">*</span> Mandatory Field</p></td> <td width="50%" align="left" valign="top"> </td> </tr> <tr> <td width="50%" align="right" valign="top" class="subheads4invest">Contact Information:</td> <td width="50%" align="left" valign="top"> </td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> First Name:</td> <td width="50%" align="left" valign="top"><input name="firstname" type="text" id="firstname" /></td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> Last Name:</td> <td width="50%" align="left" valign="top"><input name="lastname" type="text" id="lastname" /></td> </tr> <tr> <td width="50%" align="right" valign="top">Title:</td> <td width="50%" align="left" valign="top"><input name="title" type="text" id="title" /></td> </tr> <tr> <td width="50%" align="right" valign="top">Organization/Company:</td> <td width="50%" align="left" valign="top"><input name="org_company" type="text" id="org_company" /></td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> Address Line 1:</td> <td width="50%" align="left" valign="top"><input name="address_line_1" type="text" id="address_line_1" /></td> </tr> <tr> <td width="50%" align="right" valign="top">Address Line 2:</td> <td width="50%" align="left" valign="top"><input name="address_line_2" type="text" id="address_line_2" /></td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> City:</td> <td width="50%" align="left" valign="top"><input name="city" type="text" id="city" /></td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> State:</td> <td width="50%" align="left" valign="top"><select name="state" id="select"> <option selected="selected">Select State</option> <option value="AL">Alabama</option> <option value="AK">Alaska</option> <option value="AZ">Arizona</option> <option value="AR">Arkansas</option> <option value="CA">California</option> <option value="CO">Colorado</option> <option value="CT">Connecticut</option> <option value="DE">Delaware</option> <option value="DC">District of Columbia</option> <option value="FL">Florida</option> <option value="GA">Georgia</option> <option value="HI">Hawaii</option> <option value="ID">Idaho</option> <option value="IL">Illinois</option> <option value="IN">Indiana</option> <option value="IA">Iowa</option> <option value="KS">Kansas</option> <option value="KY">Kentucky</option> <option value="LA">Louisiana</option> <option value="ME">Maine</option> <option value="MD">Maryland</option> <option value="MA">Massachusetts</option> <option value="MI">Michigan</option> <option value="MN">Minnesota</option> <option value="MS">Mississippi</option> <option value="MO">Missouri</option> <option value="MT">Montana</option> <option value="NE">Nebraska</option> <option value="NV">Nevada</option> <option value="NH">New Hampshire</option> <option value="NJ">New Jersey</option> <option value="NM">New Mexico</option> <option value="NY">New York</option> <option value="NC">North Carolina</option> <option value="ND">North Dakota</option> <option value="OH">Ohio</option> <option value="OK">Oklahoma</option> <option value="OR">Oregon</option> <option value="PA">Pennsylvania</option> <option value="PR">Puerto Rico</option> <option value="RI">Rhode Island</option> <option value="SC">South Carolina</option> <option value="SD">South Dakota</option> <option value="TN">Tennessee</option> <option value="TX">Texas</option> <option value="UT">Utah</option> <option value="VT">Vermont</option> <option value="VA">Virginia</option> <option value="VI">Virgin Islands</option> <option value="WA">Washington</option> <option value="WV">West Virginia</option> <option value="WI">Wisconsin</option> <option value="WY">Wyoming</option> </select></td> </tr> <tr> <td width="50%" align="right" valign="top">If International, enter province here:</td> <td width="50%" align="left" valign="top"><input name="province" type="text" id="province" /></td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> Zip:</td> <td width="50%" align="left" valign="top"><input name="zip" type="text" id="zip" /></td> </tr> <tr> <td width="50%" align="right" valign="top">Preferred Phone:</td> <td width="50%" align="left" valign="top"><input name="phone" type="text" id="phone" /></td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> E-mail Address:</td> <td width="50%" align="left" valign="top"><input name="email" type="text" id="email" /></td> </tr> <tr> <td width="50%" align="right" valign="top">My Contact Information Address is my Home Address</td> <td width="50%" align="left" valign="top"><input name="home_address" type="checkbox" id="home_address" value="checkbox" /></td> </tr> <tr> <td width="50%" align="right" valign="top" class="subheads4invest">Your Donation:</td> <td width="50%" align="left" valign="top"> </td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> What is the amount of your donation?</td> <td width="50%" align="left" valign="top">Choose amount <select name="amount" id="amount"> <option selected="selected">Select</option> <option>$25</option> <option>$50</option> <option>$100</option> <option>$150</option> <option>$200</option> <option>$500</option> <option>$1000</option> <option>Other</option> </select> </td> </tr> <tr> <td width="50%" align="right" valign="top">If other, please enter your donation amount:</td> <td width="50%" align="left" valign="top"><input name="OtherAmount" type="text" id="OtherAmount" /></td> </tr> <tr> <td width="50%" align="right" valign="top" class="subheads4invest">Interests:</td> <td width="50%" align="left" valign="top"> </td> </tr> <tr> <td width="50%" align="right" valign="top">I would like to receive information on the following (check all that apply):</td> <td width="50%" align="left" valign="top"><p> <input name="Interests" type="checkbox" id="Interests" value="Publicize" /> Helping publicize the need for vests<br /> <input name="Interests" type="checkbox" id="Interests" value="RaiseMoney" /> Helping raise money<br /> <input name="Interests" type="checkbox" id="Interests" value="Programs" /> Programs in my community<br /> <input name="Interests" type="checkbox" id="Interests" value="Sponsorships" /> Sponsorship opportunities<br /> <input name="Interests" type="checkbox" id="Interests" value="CompanyInvolved" /> Getting my company involved<br /> <input name="Interests" type="checkbox" id="Interests" value="Volunteering" /> Volunteering<br /> <input name="Interests" type="checkbox" id="Interests" value="Education" /> Education<br /> <input name="Interests" type="checkbox" id="Interests" value="PoliticalAction" /> Political action<br /> <input name="Interests" type="checkbox" id="Interests" value="Endowments" /> Endowments<br /> <input name="Interests" type="checkbox" id="Interests" value="Partnerships" /> Partnerships with other organizations<br /> <input name="Interests" type="checkbox" id="Interests" value="Other" /> Other (Please specify below) </p> <p> <input name="OtherInterest" type="text" id="OtherInterest" /> </p></td> </tr> <tr> <td width="50%" align="right" valign="top" class="subheads4invest">Comments:</td> <td width="50%" align="left" valign="top"> </td> </tr> <tr> <td width="50%" align="right" valign="top">Enter any comments:</td> <td width="50%" align="left" valign="top"><textarea name="Comments" id="Comments"></textarea></td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> Mandatory Field</td> <td width="50%" align="left" valign="top"> </td> </tr> <tr> <td width="50%" align="right" valign="top"><p><span class="subheads4invest">Billing Information:</span><br /> Please fill out your billing information below.<br /> <em class="pred">Note: The information you enter here must match the name and address to which your credit card statements are sent. Failure to do so may cause this transaction to be declined.</em></p> </td> <td width="50%" align="left" valign="top"> </td> </tr> <tr> <td align="right" valign="top">Check here if the billing information is the same as contact informaton above (if so, please go to the credit card information). </td> <td align="left" valign="top"><input name="same_as_ contact_info" type="checkbox" id="same_as_ contact_info" value="Yes" /></td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> First Name:</td> <td width="50%" align="left" valign="top"><input name="first_name_billing" type="text" id="first_name_billing" /></td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> Last Name:</td> <td width="50%" align="left" valign="top"><input name="last_name_billing" type="text" id="last_name_billing" /></td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> Address Line 1:</td> <td width="50%" align="left" valign="top"><input name="address_line_1_billing" type="text" id="address_line_1_billing" /></td> </tr> <tr> <td width="50%" align="right" valign="top">Address Line 2:</td> <td width="50%" align="left" valign="top"><input name="address_line_2_billing" type="text" id="address_line_2_billing" /></td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> City:</td> <td width="50%" align="left" valign="top"><input name="city_billing" type="text" id="city_billing" /></td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> State:</td> <td width="50%" align="left" valign="top"> <select name="state_billing" id="state_billing"> <option selected="selected">Select State</option> <option value="AL">Alabama</option> <option value="AK">Alaska</option> <option value="AZ">Arizona</option> <option value="AR">Arkansas</option> <option value="CA">California</option> <option value="CO">Colorado</option> <option value="CT">Connecticut</option> <option value="DE">Delaware</option> <option value="DC">District of Columbia</option> <option value="FL">Florida</option> <option value="GA">Georgia</option> <option value="HI">Hawaii</option> <option value="ID">Idaho</option> <option value="IL">Illinois</option> <option value="IN">Indiana</option> <option value="IA">Iowa</option> <option value="KS">Kansas</option> <option value="KY">Kentucky</option> <option value="LA">Louisiana</option> <option value="ME">Maine</option> <option value="MD">Maryland</option> <option value="MA">Massachusetts</option> <option value="MI">Michigan</option> <option value="MN">Minnesota</option> <option value="MS">Mississippi</option> <option value="MO">Missouri</option> <option value="MT">Montana</option> <option value="NE">Nebraska</option> <option value="NV">Nevada</option> <option value="NH">New Hampshire</option> <option value="NJ">New Jersey</option> <option value="NM">New Mexico</option> <option value="NY">New York</option> <option value="NC">North Carolina</option> <option value="ND">North Dakota</option> <option value="OH">Ohio</option> <option value="OK">Oklahoma</option> <option value="OR">Oregon</option> <option value="PA">Pennsylvania</option> <option value="PR">Puerto Rico</option> <option value="RI">Rhode Island</option> <option value="SC">South Carolina</option> <option value="SD">South Dakota</option> <option value="TN">Tennessee</option> <option value="TX">Texas</option> <option value="UT">Utah</option> <option value="VT">Vermont</option> <option value="VA">Virginia</option> <option value="VI">Virgin Islands</option> <option value="WA">Washington</option> <option value="WV">West Virginia</option> <option value="WI">Wisconsin</option> <option value="WY">Wyoming</option> </select></td> </tr> <tr> <td width="50%" align="right" valign="top">If International, enter province here:</td> <td width="50%" align="left" valign="top"><input name="province_billing" type="text" id="province_billing" /></td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> Zip:</td> <td width="50%" align="left" valign="top"><input name="zip_billing" type="text" id="zip_billing" /></td> </tr> <tr> <td width="50%" align="right" valign="top">Country (if not in USA) :</td> <td width="50%" align="left" valign="top"><input name="country_billing" type="text" id="country_billing" /></td> </tr> <tr> <td width="50%" align="right" valign="top">Phone Number:</td> <td width="50%" align="left" valign="top"><input name="phone_billing" type="text" id="phone_billing" /></td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> E-mail Address:</td> <td width="50%" align="left" valign="top"><input name="email_billing" type="text" id="email_billing" /></td> </tr> <tr> <td width="50%" align="right" valign="top"><strong class="subheads4invest">Credit Card Information:</strong></td> <td width="50%" align="left" valign="top"> </td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> Credit Card Type:</td> <td width="50%" align="left" valign="top"><select name="card_type" id="card_type"> <option>Select card type</option> <option>Visa</option> <option>Mastercard</option> </select> </td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> Credit Card Number:</td> <td width="50%" align="left" valign="top"><input name="cc_number" type="text" id="cc_number" /></td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> Security Code:</td> <td width="50%" align="left" valign="top"><input name="security_code" type="text" id="security_code" /> <br /> <img src="images/visacode.jpg" alt="Visa Mastercard Security Code" width="107" height="75" /></td> </tr> <tr> <td width="50%" align="right" valign="top"><span class="pred">*</span> Expiration Date:</td> <td width="50%" align="left" valign="top"><select name="cardexpmonth" size="1"> <option selected>Jan</option> <option>Feb</option> <option>Mar</option> <option>Apr</option> <option>May</option> <option>Jun</option> <option>Jul</option> <option>Aug</option> <option>Sep</option> <option>Oct</option> <option>Nov</option> <option>Dec</option> </select> <select name="cardexpyear" size="1"> <option value="2008">2008</option> <option value="2009">2009</option> <option value="2010">2010</option> <option value="2011">2011</option> <option value="2012">2012</option> <option value="2013">2013</option> </select></td> </tr> <tr> <td width="50%" align="right" valign="top"> </td> <td width="50%" align="left" valign="top"> </td> </tr> <tr> <td colspan="2" align="left" valign="top"><div align="center"> <input type="submit" name="Submit" value="Submit" /> </div></td> </tr> </table> </form> <p> </p> <p class="heads4invest"><br /> </p></td> </tr> </table> <p> </p> <table width="800" border="0" align="center" cellpadding="5" cellspacing="0" bgcolor="#000000"> <tr> <td><div align="center" class="footer"><a href="index.html">Home</a> | <a href="mission.html">Mission</a> | <a href="videos.html">Videos</a> | <a href="programs.html">Programs</a> |<a href="sponsors.html"> Sponsors</a> | <a href="getinvolved.html">Get Involved</a> | <a href="contact.html">Contact</a> | <a href="buygear.html">Buy Gear</a> | Site Design by <a href="http://www4dadvertising.com">4D Advertising</a></div></td> </tr> </table> </body> </html>
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