[%# The contents of this file are subject to the Mozilla Public # License Version 1.1 (the "License"); you may not use this file # except in compliance with the License. You may obtain a copy of # the License at http://www.mozilla.org/MPL/ # # Software distributed under the License is distributed on an "AS # IS" basis, WITHOUT WARRANTY OF ANY KIND, either express or # implied. See the License for the specific language governing # rights and limitations under the License. # # The Original Code is the REMO Extension # # The Initial Developer of the Original Code is the Mozilla Foundation # Portions created by the Initial Developers are Copyright (C) 2011 the # Initial Developer. All Rights Reserved. # # Contributor(s): # Dave Lawrence #%] [% PROCESS global/variables.none.tmpl %] [% PROCESS global/header.html.tmpl title = "Mozilla Reps Payment Form" generate_api_token = 1 style_urls = [ 'extensions/REMO/web/styles/moz_reps.css' ] javascript_urls = [ 'extensions/REMO/web/js/form_validate.js', 'extensions/REMO/web/js/payment.js', 'js/util.js', 'js/field.js' ] yui = ['connection', 'json'] %]

Mozilla Reps - Payment Form

First Name: *
Last Name: *
Wiki user profile:*
Event wiki page: *
Budget request [% terms.bug %]: *
Have you already received payment for this event?
Expense form and scanned receipts/invoices:
Expense Form: *
Receipts File: *
Please black out any bank account information included
on receipts before attaching them.
 

* - Required field
Thanks for contacting us.

[% PROCESS global/footer.html.tmpl %]