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<% if request.querystring("show") = "" Then %>
TASF One Brick At A Time Fundraiser Purchase Form
Support the Tupac Amaru Shakur Foundation by purchasing a brick engraved with your company logo
or your own personal message! Your brick will be constructed into the Peace Garden of
the Tupac Shakur Center for the Arts.
<% End If %>
<% If request.querystring("show") = "verify" Then
' A Function to check if some field entered by user is empty
Function ChkString(string)
If string = "" Then string = ""
ChkString = Replace(string, "'", "''")
End Function
dim fname, lname, address1, city, st, zip, ph, fx, em, itemName, itemMessage, itemMessage2, specialarea, pmtmethod
fname = ChkString(request.form("field_fname"))
lname = ChkString(request.form("field_lname"))
address1 = ChkString(request.form("field_address"))
city = ChkString(request.form("field_city"))
st = ChkString(request.form("field_state"))
zip = ChkString(request.form("field_zip"))
ph = ChkString(request.form("field_phone"))
fx = ChkString(request.form("field_fax"))
em = ChkString(request.form("field_email"))
itemName = ChkString(request.form("field_BrickType"))
specialarea = ChkString(request.form("field_special_area"))
itemMessage = ChkString(request.form("field_message"))
itemMessage2 = ChkString(request.form("field_message2"))
pmtmethod = ChkString(request.form("field_paymenttype"))
dim thebrickmessage, thebrickprice
if itemName = "Friends of PAC Brick" then
thebrickprice = "100.00"
end if
if itemName = "Commemorative VIP Brick" then
thebrickprice ="1000.00"
end if
if itemName = "Happy 60th Afeni Brick" then
thebrickprice ="60.00"
end if
if itemName = "Friends of PAC Brick" and itemMessage <> "" then
thebrickmessage = itemMessage
else
thebrickmessage = itemMessage2
end if
%>
TASF One Brick At A Time Fundraiser Purchase Form
Please take a moment to verify your information. If the information is correct follow the instructions
below, if you need to edit any of your information please use your browsers BACK button to go
back and make the necessary edits.
| Name: |
<%=fname%> <%=lname%> |
| Address: |
<%=address1%> |
| <%=city%>, <%=st%> <%=zip%> |
| Phone / Fax: |
<%=ph%> <% if fx <> "" Then%> / <%=fx%><% End If%> |
| Email: |
<%=em%> |
| Item Purchased: |
<%=itemname%> |
| Special Area: |
<%=specialarea%> |
| Message for Brick: |
<%=thebrickmessage%> |
| Payment Method: |
<%=pmtmethod%> |
To Complete Your Order...
<% if pmtmethod = "Credit Card (online)" Then %>
<% End if %>
<% if pmtmethod = "Check / Money Order (mail)" Then%>
Print this page and mail it, along with your check or money order (made payable to Tupac Amaru Shakur Foundation, Inc.) to the following address:
Tupac Amaru Shakur Foundation, Inc.
One Brick at A Time
P.O. Box 831717
Stone Mountain, GA 30083
<% End If%>
All donations are tax deductible - ID# 582512839.
If you have any questions, please contact Marita Greenbridge at 404-298-4222
<% End If%>
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