[paytium name="Zinvol om Tafel" description="Steunen" amount=""]
[paytium_field type="name" label="Naam" required="true" /]
[paytium_field type="email" label="E-mailadres" required="true" /][paytium_field type="radio" label="Kies je bedrag" options="20/50/100/Ander bedrag" options_are_amounts="true" /][paytium_field type="open" label="Bedrag" placeholder="Vul hier het gewenste bedrag in" /]
[paytium_total label="Totaalbedrag" /]
[paytium_field type="terms" label="Ik ga akkoord met het Privacybeleid" link="/privacybeleid/" required="true" /]
[paytium_button label="Geven" /]
[paytium_emails id="301,302" /]
[/paytium]