If paying by Credit/Debit – use the form below to design your brick and submit for payment to PHA

If paying by Check – Click Here for form download Click Here

<% Dim TBoxVal Dim SessVal TBoxVal = Request.Form("CaptchaStr") SessVal = Session("Captcha") Function EncryptText(strText,ByVal strPwd) Dim i , c Dim strBuff If strPwd <> "" And strText <> "" Then strPwd = UCase(strPwd) If Len(strPwd) Then For i = 1 To Len(strText) c = Asc(Mid(strText, i, 1)) c = c + Asc(Mid(strPwd, (i Mod Len(strPwd)) + 1, 1)) strBuff = strBuff & Chr(c And &HFF) Next Else strBuff = strText End If EncryptText = strBuff Else EncryptText = "" End If End Function imagenumber = DBPrep2(request("imagenumber")) if not isnumeric(imagenumber) or trim(imagenumber) = "" then imagenumber = 0 iFlag=0 pamount = DBPrep2(request("pamount")) ' is there an image? Yes, then $10 more if imagenumber>0 then pamount = pamount + 10 bfname = DBPrep2(request("bfname")) blname = DBPrep2(request("blname")) bcomp = DBPrep2(request("bcomp")) cardaddress = DBPrep2(request("cardaddress")) cardaddress2 = DBPrep2(request("cardaddress2")) cardcity = DBPrep2(request("cardcity")) cardstate = DBPrep2(request("cardstate")) cardzip = DBPrep2(request("cardzip")) payment_type = 3 'DBPrep2(request("payment_type")) ' 3 is a paypal cctype = DBPrep2(request("cctype")) cardnumber = DBPrep2(request("cardnumber")) cmonth = DBPrep2(request("cmonth")) cyear = DBPrep2(request("cyear")) ccccv = DBPrep2(request("ccccv")) email = DBPrep2(request("email")) phone = DBPrep2(request("phone")) AltPhone = DBPrep2(request("AltPhone")) for xx = 1 to 18 Line1 = Line1 & DBPrep2(request("C" & xx)) if DBPrep2(request("C" & xx)) = "" then Line1 = Line1 + " " next line1 = rtrim(line1) 'response.write "Line 1: " & replace(line1," "," ") & "
" for xx = 19 to 36 Line2 = Line2 & DBPrep2(request("C" & xx)) if DBPrep2(request("C" & xx)) = "" then Line2 = Line2 + " " next line2 = rtrim(line2) 'response.write "Line 2: " & replace(line2," "," ") & "
" for xx = 37 to 54 Line3 = Line3 & DBPrep2(request("C" & xx)) if DBPrep2(request("C" & xx)) = "" then Line3 = Line3 + " " next line3 = rtrim(line3) 'response.write "Line 3: " & replace(line3," "," ") & "
" for xx = 55 to 72 Line4 = Line4 & DBPrep2(request("C" & xx)) if DBPrep2(request("C" & xx)) = "" then Line4 = Line4 + " " next line4 = rtrim(line4) 'response.write "Line 4: " & replace(line4," "," ") & "
" LineText = Line1 & "|" & Line2 & "|" & Line3 & "|" & Line4 notes = "" ' not submitted at this time if cyear= "" then cyear =0 if cmonth= "" then cmonth =0 if cctype= "" then cctype =0 if trim(ccccv) = "" then ccccv =0 cardexpires = cmonth & "/" & cyear if request("sendform") =1 then if iFlag=0 and (trim(bfname) = "" or trim(blname) = "" or trim(cardaddress) = "" or trim(cardzip) = "") then iFlag=4 if iFlag=0 and pamount = "" then iFlag=2 if payment_type < 2 and iFlag=0 and (trim(cardnumber)= "" or len(cardnumber) < 14 or len(cmonth) = 1 or len(cyear) = 1) then iFlag=3 '''if iFlag=0 and trim(email) = "" then iFlag=5 ' removed due to client reqest if iFlag=0 and (CStr(SessVal) <> CStr(TBoxVal)) then iFlag=1 end if 'if request("sendform") =1 then ' if len(rsvptype) =1 then iFlag=2 ' if iFlag=0 and (trim(bfname) = "" or trim(blname) = "" or trim(cardaddress) = "" or trim(cardzip) = "") then iFlag=4 ' if payment_type <> 2 and iFlag=0 and (trim(cardnumber)= "" or len(cardnumber) < 14 or len(cmonth) = 1 or len(cyear) = 1) then iFlag=3 ' if iFlag=0 and trim(email) = "" then iFlag=5 ' if iFlag=0 and (CStr(SessVal) <> CStr(TBoxVal)) then iFlag=1 'end if If CStr(SessVal) = CStr(TBoxVal) and request("sendform") = 1 and iFlag =0 then if pamount <> "" then ThisOrderTotal = pamount else rsvptype = 0 pamount = 0 ThisOrderTotal = pamount end if if email = "" then email = "noemail@taylorswish.org" end if txNUM = 0 ' did the payment succeed? 1=yes NoGo =0 if payment_type < 2 then %> <% NoGo = 1 else Nogo = 1 end if ' did the payment succeed? 1=yes if Nogo = 1 then sender="info@taylorswish.org" ToEmail = email txNUM = session("tnx") if payment_type < 2 then pstatus = 3 ' complete/processed else pstatus = 1 ' new/incomplete end if session("rsvpname") = "Donation" session("rsvpprice") = pamount session("dateadded") = now() ' we try to write to file, send email and write to database. We hope one will succeed. on error resume next ''' send to admin mailbody = "" mailbody = mailbody & "Brick Order Information" & chr(13)& chr(10) &"
" mailbody = mailbody & "---------------------------------" & chr(13) & chr(10) &"
" mailbody = mailbody & "Company: " & bcomp & chr(13) & chr(10)&"
" mailbody = mailbody & "Name: " & bfname & " " & blname & chr(13) & chr(10)&"
" mailbody = mailbody & "Address: " & cardaddress & chr(13) & chr(10)&"
" mailbody = mailbody & "City: " & cardcity & chr(13) & chr(10)&"
" mailbody = mailbody & "State: "& cardstate & chr(13) & chr(10)&"
" mailbody = mailbody & "Zip: "& cardzip & chr(13) & chr(10)&"
" mailbody = mailbody & "Email: "& ToEmail & chr(13) & chr(10)&"
" mailbody = mailbody & "Phone: "& Phone & chr(13) & chr(10)&"
" mailbody = mailbody & "Alt. Phone: "& AltPhone & chr(13) & chr(10)&"
" mailbody = mailbody & "Notes: "& notes & chr(13) & chr(10)&"
" mailbody = mailbody & "---------------------------------" & chr(13) & chr(10)&"
" if payment_type < 2 then mailbody = mailbody & "CCTYPE:" & CCTYPE & chr(13) & chr(10)&"
" mailbody = mailbody & "Charged for: $"& pamount & chr(13) & chr(10)&"
" mailbody = mailbody & "Creditcard Transaction Number: "& txNUM & chr(13) & chr(10)&"
" else if payment_type=3 then mailbody = mailbody & "Payment By Paypal will be coming: $"& pamount & chr(13) & chr(10)&"
" else mailbody = mailbody & "Payment By Check: $"& pamount & chr(13) & chr(10)&"
" end if end if mailbody = mailbody & "---------------------------------" & chr(13) & chr(10)&"
" ' write file just in case email and db fail Dim objFSO Set objFSO = Server.CreateObject("Scripting.FileSystemObject") max=100 min=1 Randomize FileName = "NewOrder-" & replace(replace(replace(now() ,":","_"),"/","-")," ","!") & trim(Int((max-min+1)*Rnd+min)) & ".txt" 'response.write FileName & "
" 'response.write server.mappath("Orders") & "\" & FileName 'Open the text file Dim objTextStream Set objTextStream = objFSO.CreateTextFile(server.mappath("Orders") & "\" & FileName, true) 'Display the contents of the text file objTextStream.WriteLine MailBody & "
Image Number: " & imagenumber & "
Line Text: " & LineText & "
" 'Close the file and clean up objTextStream.Close Set objTextStream = Nothing Set objFSO = Nothing ' try to send the email call sendemail(sender , "info@taylorswish.org" , "", "" , "TAYLORSWISH Brick Order Admin Confirmation",mailbody, "") ''' send to client confirmation mailbody2 = "" mailbody2 = mailbody2 & " Taylor's Wish wants to thank you for your Brick Order which will help with the on-going fight to help cure PH." & chr(13) & chr(10)&"
" mailbody2 = mailbody2 & " Your continued support of our annual race event each year is central to supporting our mission to find a cure for PH and to enhance patient well-being."& chr(13) & chr(10)&"
" mailbody2 = mailbody2 & " Thank you again for your support," & chr(13) & chr(10)&"
" mailbody2 = mailbody2 & " Taylor's Wish" & chr(13) & chr(10)&"
" mailbody2 = mailbody2 & " www.taylorswish.org" & chr(13) & chr(10)&"
" mailbody2 = mailbody2 & " " & chr(13) & chr(10)&"
" mailbody2 = mailbody2 & " Shari Caffrey" mailbody2 = mailbody2 & " Phone: 714.200.8322" & chr(13) & chr(10)&"
" mailbody2 = mailbody2 & " Email: shari@taylorswish.org" & chr(13) & chr(10)&"


" mailbody2 = mailbody2 & "---------------------------------" & chr(13) & chr(10)&"
" mailbody2 = mailbody2 & mailbody if trim(ToEmail) <> "" then call sendemail(sender, ToEmail, "", "" , "TAYLORSWISH Brick Order Client Confirmation",mailbody2, "") end if ' try to write to the database sSQL = "INSERT INTO tblRegistration(regtype,rsvpid,company,first,last,address,address2,city,state,zip,email," sSQL = sSQL & " attendees,sitwith,notes,pamount,status,txnum,dateadded) VALUES (0," sSQL = sSQL & "0,'" & bcomp & "','" & bfname & "','" & blname & "','" & cardaddress & "','" & cardaddress2 & "','" & cardcity & "','" & cardstate & "','" sSQL = sSQL & cardzip & "','" & ToEmail & "','0','0','" & notes & "','" & pamount & "','" sSQL = sSQL & pstatus & "','" & txNUM & "','" & now() & "')" 'response.write sSQL Session("LastSQL") = sSQL objConn.Execute(sSQL) SQL = "Select max(rid) as maxid From [tblRegistration] " Session("lastSQL") = SQL Set objRs = Server.CreateObject("ADODB.Recordset") objRs.Open SQL, objConn, 3, 3 CurrentID = objRs("maxid") if CurrentID = "" then CurrentID = 0 objRs.Close 'cardnumber = "****-****-****-" & right(cardnumber,4) cardnumber = EncryptText(cardnumber,"password") sSQL = "INSERT INTO tblDonation (regID,ordertype,donatedate" if payment_type < 2 then sSQL = sSQL & ",completedate" end if sSQL = sSQL & " ,donateamount,donatemethod " sSQL = sSQL & ",fname,lname,address,city,state,zip,email,ccnum,ccmonth,ccyear,ccccv,status,notes,phonenum, cctype, imagenumber, LineText) VALUES (" sSQL = sSQL & CurrentID &",'Brick Order','" & now() & "','" if payment_type < 2 then sSQL = sSQL & now() & "','" end if sSQL = sSQL & pamount & "','" & payment_type & "','" sSQL = sSQL & bfname & "','" & blname & "','" & cardaddress & "','" & cardcity & "','" & cardstate & "','" & cardzip & "','" & ToEmail & "','" sSQL = sSQL & cardnumber & "','" & cmonth & "'," & cyear & "," & ccccv & "," & pstatus & ",'" & notes & "','" & phone & "/ " & AltPhone& "'," sSQL = sSQL & "'" & CCType & "'," & imagenumber & ",'" & LineText & "')" 'response.write sSQL Session("LastSQL") = sSQL objConn.Execute(sSQL) 'response.write TBoxVal & " - " & SessVal Session("Captcha") = "Completed" on error goto 0 %>
Thanks for your Order. You are almost finished. <% if payment_type < 2 then response.redirect("donation_confirmation.asp") else %>

Pay PHA



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<% end if %>
<% else response.write TBoxVal & " - " & SessVal Session("Captcha") = "Failed" response.redirect("failprocess.asp?fail=1") end if response.end end if %>
">
<% if iFlag=1 and request("sendform") = 1 then %>

* Invalid Verification Code. Please Try Again.

<% end if %> <% if iFlag=2 and request("sendform") = 1 then %>

* Please select an event to register for.

<% end if %> <% if iFlag=3 and request("sendform") = 1 then %>

* Credit card information is missing. Please Try Again.

<% end if %> <% if iFlag=4 and request("sendform") = 1 then %>

* Billing Address is missing. Please Try Again.

<% end if %> <% if iFlag=5 and request("sendform") = 1 then %>

* Email is missing. Please Try Again.

<% end if %>

Taylor’s Wish Brick Fundraiser at the East Anaheim Community Garden
“Paving a Path to Cure PH”


  <% for xx = 1 to 18 %> " maxlength="1" size="1" autocomplete="off" title="Character" onkeyup= "javascript:changeFocusToNextField('C<%=xx+1%>')" /> <% next 'response.write Request.ServerVariables("HTTP_USER_AGENT") tdwidth=" width=410 " if instr(lcase(Request.ServerVariables("HTTP_USER_AGENT")),"version/") >0 and instr(lcase(Request.ServerVariables("HTTP_USER_AGENT")),"safari") >0 then tdwidth= " width=430 " if instr(lcase(Request.ServerVariables("HTTP_USER_AGENT")),"chrome") >0 then tdwidth= " width=470 " 'response.write tdwidth %>
>   <% for xx = 19 to 31 %> " maxlength="1" size="1" autocomplete="off" title="Character" onkeyup= "javascript:changeFocusToNextField('C<%=xx+1%>')" /> <% next %>
  <% for xx = 37 to 49 %> " maxlength="1" size="1" autocomplete="off" title="Character" onkeyup= "javascript:changeFocusToNextField('C<%=xx+1%>')" /> <% next 'response.write Request.ServerVariables("HTTP_USER_AGENT") tdwidth=" width=296 " if instr(lcase(Request.ServerVariables("HTTP_USER_AGENT")),"version/") >0 and instr(lcase(Request.ServerVariables("HTTP_USER_AGENT")),"safari") >0 then tdwidth= " width=275 " if instr(lcase(Request.ServerVariables("HTTP_USER_AGENT")),"chrome") >0 then tdwidth= " width=200 " 'response.write tdwidth %>
> <% for xx = 32 to 36 %> " maxlength="1" size="1" autocomplete="off" title="Character" onkeyup= "javascript:changeFocusToNextField('C<%=xx+1%>')" /> <% next %>
<% for xx = 50 to 54 %> " maxlength="1" size="1" autocomplete="off" title="Character" onkeyup= "javascript:changeFocusToNextField('C<%=xx+1%>')" /> <% next %>
  <% for xx = 55 to 72 %> " maxlength="1" size="1" autocomplete="off" title="Character" onkeyup= "javascript:changeFocusToNextField('C<%=xx+1%>')" /> <% next %>

Optional images to choose from for an additional $10 charge:



(Please contact us to use Corporate Logo’s)

Billing Information


(For confirmation email)

* Case sensitive


Look is approximate. All proceeds from this fundraiser will go to the Pulmonary Hypertension Association’s research programs in Taylor’s memory in an effort to find a cure for Pulmonary Hypertension.

The Pulmonary Hypertension Association (PHA) is a non-profit 501 (c)(3) organization All donations are tax deductible