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<html>
</html>
{{2012FR/Form-section/Processing/Default
| uselang = {{{uselang}}}
| country = {{{country}}}
| appeal = {{{appeal}}}
| currency = {{2012FR/Switch/Currency/Code|{{{country}}}}}
| handler = GC
| GC-CC-ffname = cc-vm
}}
{{2012FR/Form-section/Radiobuttons/Default
| country = {{{country}}}
| uselanglanguage = {{{uselanglanguage}}}
| currency = {{2012FR/Switch/Currency/Code|{{{country}}}}}
| donate-amount-0 = 5
| donate-amount-6 = 150
}}
{{2012FR/Form-section/PaymentmethodsPaymentmethod/Creditcard}}
{{2012FR/Form-section/Paymentmethods/EWallet/PayPal}}
<html>
<div class="dividing-line" id="form-line"></div>
<div id="donor-infobox-block">
</html>{{2012FR/Form-section/Infobox
| infobox = 2012FR/Form-section/Infobox/{{{infobox|Default}}}
| appeal = {{{appeal|Default}}}
| language = {{int:lang}}
| country = {{{country|XX}}}
}}<html>
</div>
</html>
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