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</style>
</html>
{{2012FR/Form-section/Processing/Default
| language = {{{language}}}
| country = {{{country}}}
| appeal = {{{appeal}}}
| currency = USD
| handler = GC
| GC-CC-ffname = cc-vmad
}}
{{2012FR/Form-section/Radiobuttons/3-buttons
| country = {{{country}}}
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| donate-amount-2 = 1000
}}
{{2012FR/Form-section/PaymentmethodsPaymentmethod/Creditcard}}
{{2012FR/Form-section/Paymentmethods/EWalletPaymentmethod/PayPal}}
{{2012FR/Form-section/Paymentmethods/EWalletPaymentmethod/Amazon}}
<html>
</html>
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