Form Not Submitting

Thanks for taking a look – here you go:

[ Moderator note: code fixed. Please wrap code in the backtick character or use the code button. ]

<small>I wish to donate using the secure form below:</small>
<div id="donate-inputs">

<div class="twocol first">
<p>$ [text donate-where-most-needed]</p>
</div>
<div class="tencol">
<p><strong>Where Most Needed</strong></p>
</div>
<div class="clearfix"></div>
<div class="twocol first">
<p>$ [text donate-2016-golf-tournament]</p>
</div>
<div class="tencol">
<p><strong>2016 Golf Tournament</strong> - annual fundraiser in which proceeds support programs and services in our communities</p>
</div>
<div class="clearfix"></div>
<div class="twocol first">
<p>$ [text donate-supporters-campaign]</p>
</div>
<div class="tencol">
<p><strong>Supporters Campaign</strong> - our annual giving campaign directly supports programs and services for residents in all of our communities</p>
</div>
<div class="twocol first">
<p>$ [text donate-staff-appreciation-funds]</p>
</div>
<div class="tencol">
<p><strong>Staff Appreciation Funds</strong> - we encourage donors seeking to express their appreciation of care given by an individual or team to honor with a donation, in their name(s), to this fund. Resources from staff appreciation funds support tuition reimbursement, staff development initiatives, as well as financial assistance to staff members in times of need.</p>
</div>
<div class="clearfix"></div>
<div class="twocol first">
<p>$ [text donate-united-way]</p>
</div>
<div class="tencol">
<p><strong>United Way Donor Option</strong> - a convenient way to advance our mission, these designated donations support and enhance the quality of life for our residents. Our donor option number is #1420.</p></div>
<div class="clearfix"></div>
<div class="twocol first">
<p>$ [text donate-chapel-memorial-fund]</p>
</div>
<div class="tencol">
<p><strong>Chapel Memorial Fund</strong> - our primary fund for donations in honor or in memory of someone special. Donations support the ministry and service of the Chaplain to all those in our care.</p>
</div>
<div class="clearfix"></div>
<div class="twocol first">
<p>$ [text donate-resident-quality] </p>
</div>
<div class="tencol last">
<p><strong>Rockwood Jenkins Resident Life Fund</strong> - to honor former Administrator Rockwood Jenkins, this fund was established to support activities and other expenses that improve the quality of life for our residents.</p>
</div>
<div class="clearfix"></div>
<div class="twocol first">
<p>$ <span class="wpcf7-form-control-wrap donate-resident-quality"><input type="text" name="donate-jeanie's-closet" value="" size="40" class="wpcf7-form-

control wpcf7-text" aria-invalid="false" /></span></p> </div>
<div class="tencol last">
<p><strong>Jeanie's Closet</strong> - designated donations that offer staff the opportunity to provide their children or grandchildren an accessory or clothing to match an occasion. </p>
</div>
<div class="clearfix"></div>
<div class="twocol first">
<p>$ [text donate-debs-art-fund] </p>
</div>
<div class="tencol">
<p><strong>Deb's Art Fund</strong> - designated support for the purchase of artwork throughout our commnities.</p>
</div>
<div class="clearfix"></div>
</div>
<div id="total-donation">Total Gift $0</div>
<div id="total-donation-hidden" style="display:none;">0</div>
	</div>
	<div class="clearfix"></div>

<p>Please fill out name and mailing address completely so that we may send you materials regarding your contribution:</p>
<p>[radio number-of-donations "This is my first donation to Episcopal SeniorLife Communities." "I have donated to Episcopal SeniorLife Communities in the 

past."]</p>

<div class="fourcol first"><p>First Name:
[text* your-first-name 25/]</p></div>

<div class="fourcol "><p>Middle Initial:
[text your-middle-name 25/]</p></div>

<div class="fourcol last"><p>Last Name:
[text* your-last-name 25/]</p></div>
<div class="clearfix"></div>

<div class="fourcol first"><p>Address:
[text* address 25/]</p></div>

<div class="fourcol "><p>City:
[text* city 25/]</p></div>

<div class="fourcol last"><p>State:
[text* state 25/]</p></div>
<div class="clearfix"></div>

<div class="fourcol first"><p>Zip:
[text* zip 25/]</p></div>

<div class="fourcol "><p>Preferred Phone:
[text* your-pref-phone 25/]</p></div>

<div class="fourcol last"><p>Alternate Phone:
[text your-alt-phone 25/]</p></div>
<div class="fourcol first">
<p>Email:
[email your-email 25/]
</div>
<div class="clearfix"></div>
<p>Any other comments ?
[textarea comments]</p>

<p>[class:button "Proceed to Payment"]</p>
<strong><font color="red">When you click 'Proceed to Payment' you will be directed to our payment page within 5 seconds.</strong></font>

Honestly, I have no idea. I took this site over from someone so I didn’t build most of it. I tried to remove that just now, but the input field next to Jeanies Closet disappeared when I did, so I put it back.

Thanks for your continued help!

Anyone? Please?