Donate a USA Teddy Bear

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Donation Levels 
  Level
    20 Bears - $1000 
    10 Bears - $500 
    5 Bears - $250 
    2 Bears - $100 
    1 Bear - $50 
* required information
Donation
Select Gift Frequency
I would like to make a one-time gift for the following amount:
:* $
I would like to make a recurring gift.
 Gift Amount* Payment Frequency
  $
NOTE: This transaction will count as the first payment toward your total gift amount.
Donor Information
First Name:*
Last Name:*
Email:*
Phone:
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Country:
Payment Information
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Credit Card Type:*
Credit Card Expiration:*
Billing Information
If the billing information is the same as the contact information check this box.
If not please fill out the information below:
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State:
:
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Country:*
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