Template:2011FR/lp-form-GB7amounts-wherebox-GC

{{{gift-amount-text}}}

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