Foursquare // Chaplains Form HTML

gistfile1.html

<form method="post" action="https://secure-q.net/Pages/Post" enctype="application/x-www-form-urlencoded" >
<input type="hidden" id="merchantid" name="merchantid" value="ICFGCQ" />
<input type="hidden" id="pageid" name="pageid" value="4504" />
<input type="hidden" id="Organization" name="Organization" value="" />
<input type="hidden" id="Prefix" name="Prefix" value="" />
<input type="hidden" id="FirstName" name="FirstName" value="" />
<input type="hidden" id="LastName" name="LastName" value="" />
<input type="hidden" id="Suffix" name="Suffix" value="" />
<input type="hidden" id="Address1" name="Address1" value="" />
<input type="hidden" id="City" name="City" value="" />
<input type="hidden" id="St" name="St" value="" />
<input type="hidden" id="Zip" name="Zip" value="" />
<input type="hidden" id="Country" name="Country" value="" />
<input type="hidden" id="Phone" name="Phone" value="" />
<input type="hidden" id="Email" name="Email" value="" />
<input type="hidden" id="UniqueID" name="UniqueID" value="" />
<input type="hidden" id="Amount" name="Amount" value="" />
<input type="hidden" id="selFrequency" name="selFrequency" value="" />
<input type="hidden" id="donationStartDate" name="donationStartDate" value="" />
<input type="hidden" id="donationEndDate" name="donationEndDate" value="" />
<!-- This is Designate this payment for: on your page -->
<input type="hidden" id="custom_0" name="custom_0" value="" />
<!-- This is Memo on your page -->
<input type="hidden" id="custom_1" name="custom_1" value="" />
<input type="hidden" id="gridLineItem" name="gridLineItem" value="" />
<input type="hidden" id="returnURL" name="returnURL" value="https://www.foursquare.org/chaplains/support/thanks" />
<input type="submit" id="submit" class="button--primary" name="submit" value="Give Now" />
</form>