Template:2011FR/lp-form-US7amounts-wherebox-GC

{{{gift-amount-text}}}

${{{donate-amount-0}}}	${{{donate-amount-1}}}	${{{donate-amount-2}}}	${{{donate-amount-3}}}
${{{donate-amount-4}}}	${{{donate-amount-5}}}	${{{donate-amount-6}}}	Other: