www.weareplannedparenthood.org Open in urlscan Pro
45.60.33.183  Public Scan

Submitted URL: https://urgentsupportppgny.org/
Effective URL: https://www.weareplannedparenthood.org/a/urgentsupportppgny
Submission: On November 12 via api from US — Scanned from DE

Form analysis 1 forms found in the DOM

POST v1

<form class="clearfix" method="post" novalidate="" action="v1" accept-charset="utf-8" autocomplete="on">
  <div class="at-markup FastAction" id="NVContributionForm2069360-FastAction">
    <div class="fastaction-block">
      <div class="fastAction clearfix">
        <p>
          <span class="fa-cta">
            <a href="#fastaction-login" class="profile-link" aria-label="FastAction">
        <img class="profile-link-fa-image" src="//static.everyaction.com/ea-actiontag/assets/images/fast-action.svg">
      </a>
            <span><a href="https://fastaction.ngpvan.com##whats-this" class="circle" id="fastaction-whatsthis" data-popup="true" data-popup-width="515" data-popup-height="540" target="_blank">?</a></span>
          </span>
          <span class="fa-lead"> Take future action with a single click.<br>
            <a href="#fastaction-login" class="call-modal" id="fastaction-widget-login">Log in</a>&nbsp;or&nbsp; <a href="#fastaction-signup" class="call-modal" id="fastaction-widget-signup">Sign up</a>&nbsp;for <i>Fast</i><b>Action</b>
          </span>
        </p>
      </div>
    </div>
  </div>
  <ol class="at-steps clearfix">
    <li data-step="0" class="at-step active">
      <a title="" href="#ContributionInformation">
                    <span class="step-title">Amount</span>
                </a>
    </li>
    <li data-step="1" class="at-step ">
      <a title="" href="#ContactInformation">
                    <span class="step-title">Details</span>
                </a>
    </li>
    <li data-step="2" class="at-step ">
      <a title="" href="#PaymentInformation">
                    <span class="step-title">Payment</span>
                </a>
    </li>
  </ol>
  <div class="at-error-console"></div>
  <div data-name="undefined" data-subview="submit_view" data-subview-index="2"></div>
  <fieldset class="at-fieldset ContributionInformation" id="NVContributionForm2069360-ContributionInformation" style="border: none;">
    <legend class="at-legend">Amount</legend>
    <div class="at-fields">
      <div class="at-row at-row-full ">
        <div class="form-unit form-unit-radio form-item-selectedfrequency" id="NVContributionForm2069360-ContributionInformation-SelectedFrequency">
          <div class="radios" role="radiogroup" aria-labelledby="NVContributionForm2069360-ContributionInformation-SelectedFrequency">
            <label title="One-Time" class="at-radio-label-0" role="radio">
              <input type="radio" name="SelectedFrequency" checked="" value="0"> One-Time </label><label title="Monthly" class="at-radio-label-4" role="radio">
              <input type="radio" name="SelectedFrequency" value="4"> Monthly </label>
          </div>
        </div>
      </div>
      <div class="at-row at-row-full ">
        <input id="ProcessingCurrency_Value" type="hidden" name="ProcessingCurrency.Value" value="USD">
      </div>
      <div class="at-row at-row-full ">
        <div class="form-item form-type-radios form-item-selectamount" id="NVContributionForm2069360-ContributionInformation-SelectAmount">
          <div class="at-row SelectAmount OtherAmount NonRecurringButtons">
            <div class="at-radio">
              <div class="at-radios clearfix">
                <label class="label-amount" title="$250">
                  <input name="SelectAmount" type="radio" value="250.00"> $250 <a></a> </label><label class="label-amount" title="$500">
                  <input name="SelectAmount" type="radio" value="500.00"> $500 <a></a> </label><label class="label-amount" title="$1,000">
                  <input name="SelectAmount" type="radio" value="1000.00"> $1,000 <a></a> </label><label class="label-amount" title="$2,500">
                  <input name="SelectAmount" type="radio" value="2500.00"> $2,500 <a></a> </label><label class="label-amount label-otheramount" title="Other">
                  <input name="SelectAmount" type="radio" class="radio-other" value="other"> Other <input type="number" tabindex="-1" autocomplete="transaction-amount" class="edit-otheramount" name="OtherAmount" title="Other Amount"
                    placeholder="0.00">
                  <span class="label-otheramount-prefix">$</span>
                </label>
              </div>
            </div>
          </div>
        </div>
      </div><label class="at-check  CoverCostsAmount" id="NVContributionForm2069360-ContributionInformation-CoverCostsAmount"><input type="checkbox" name="CoverCostsAmount"> <span class="at-checkbox-title-container"><span class="at-checkbox-title"
            id="NVContributionForm2069360-ContributionInformation-CoverCostsAmount-label">I'd like to help cover the transaction fees for my donation</span></span>
      </label>
    </div>
  </fieldset>
  <fieldset class="at-fieldset TributeGift" id="NVContributionForm2069360-TributeGift">
    <div class="at-fields">
      <div class="at-row at-row-full EnableTributeGift">
        <label class="at-check  EnableTributeGift" id="NVContributionForm2069360-TributeGift-EnableTributeGift"><input type="checkbox" name="EnableTributeGift"> <span class="at-checkbox-title-container"><span class="at-checkbox-title"
              id="NVContributionForm2069360-TributeGift-EnableTributeGift-label">I'd like to make this contribution in honor or in memory of someone</span></span>
        </label>
      </div>
      <div class="at-row">
        <div class="at-tribute-gift" style="display:none">
          <div class="form-unit form-unit-radio form-item-inhonororinmemoryof" id="NVContributionForm2069360-TributeGift-InHonorOrInMemoryOf"><label id="NVContributionForm2069360-TributeGift-InHonorOrInMemoryOf"> Is this an Honorary or Memorial
              Gift?</label>
            <div class="radios" role="radiogroup" aria-labelledby="NVContributionForm2069360-TributeGift-InHonorOrInMemoryOf">
              <label title="In honor of" class="at-radio-label-2" role="radio">
                <input type="radio" name="InHonorOrInMemoryOf" checked="" value="2"> In honor of </label><label title="In memory of" class="at-radio-label-1" role="radio">
                <input type="radio" name="InHonorOrInMemoryOf" value="1"> In memory of </label>
            </div>
          </div><label class="at-text   HonoreeName" id="NVContributionForm2069360-TributeGift-HonoreeName">Honoree Name <small>(Optional)</small><input type="text" autocomplete="on" false="" title="Honoree Name" name="HonoreeName" value=""
              maxlength="100">
          </label>
        </div>
      </div>
    </div>
  </fieldset>
  <fieldset class="at-fieldset RecipientInformation" id="NVContributionForm2069360-RecipientInformation" style="display: none;">
    <div class="at-fields">
      <div class="at-row">
        <label class="at-check  IncludeRecipient" id="NVContributionForm2069360-RecipientInformation-IncludeRecipient"><input type="checkbox" name="IncludeRecipient"> <span class="at-checkbox-title-container"><span class="at-checkbox-title"
              id="NVContributionForm2069360-RecipientInformation-IncludeRecipient-label">I'd like to notify someone of this contribution</span></span>
        </label>
      </div>
      <div class="at-recipient-info" style="display: none;">
        <div class="at-title">Who would you like to notify?</div>
        <div class="at-row at-row-solo at-row-full RecipientInfoHeaderHtml">
          <div class="at-markup RecipientInfoHeaderHtml" id="NVContributionForm2069360-RecipientInformation-RecipientInfoHeaderHtml">A message will be sent to the recipient to inform them of your contribution. Customize the notification by adding a
            personal message.</div>
        </div>
        <div class="at-row RecipientFirstName RecipientLastName"><label class="at-text   RecipientFirstName" id="NVContributionForm2069360-RecipientInformation-RecipientFirstName">First Name <small>(Optional)</small><input type="text"
              autocomplete="on" false="" title="First Name" name="RecipientFirstName" value="" maxlength="50">
          </label><label class="at-text   RecipientLastName" id="NVContributionForm2069360-RecipientInformation-RecipientLastName">Last Name <small>(Optional)</small><input type="text" autocomplete="on" false="" title="Last Name"
              name="RecipientLastName" value="" maxlength="50">
          </label></div>
        <div class="at-row at-row-solo RecipientStreetAddress"><label class="at-text   RecipientStreetAddress" id="NVContributionForm2069360-RecipientInformation-RecipientStreetAddress">Street Address <small>(Optional)</small><input type="text"
              autocomplete="on" false="" title="Street Address" name="RecipientStreetAddress" value="" maxlength="100">
          </label></div>
        <div class="at-row RecipientPostalCode RecipientCity RecipientStateProvince"><label class="at-text   RecipientPostalCode" id="NVContributionForm2069360-RecipientInformation-RecipientPostalCode">Postal Code <small>(Optional)</small><input
              type="tel" autocomplete="on" pattern="^\d{5}([\-]\d{4})?$" false="" title="Postal Code" name="RecipientPostalCode" value="" maxlength="10">
          </label><label class="at-text   RecipientCity" id="NVContributionForm2069360-RecipientInformation-RecipientCity">City <small>(Optional)</small><input type="text" autocomplete="on" false="" title="City" name="RecipientCity" value=""
              maxlength="25">
          </label><label class="at-select RecipientStateProvince" id="NVContributionForm2069360-RecipientInformation-RecipientStateProvince">State/Province <small>(Optional)</small><select autocomplete="on" title="State/Province"
              name="RecipientStateProvince" class="" id="NVContributionForm2069360-RecipientInformation-RecipientStateProvince-select">
              <option value="">- State -</option>
              <option value="AK">AK</option>
              <option value="AL">AL</option>
              <option value="AR">AR</option>
              <option value="AZ">AZ</option>
              <option value="CA">CA</option>
              <option value="CO">CO</option>
              <option value="CT">CT</option>
              <option value="DC">DC</option>
              <option value="DE">DE</option>
              <option value="FL">FL</option>
              <option value="GA">GA</option>
              <option value="HI">HI</option>
              <option value="IA">IA</option>
              <option value="ID">ID</option>
              <option value="IL">IL</option>
              <option value="IN">IN</option>
              <option value="KS">KS</option>
              <option value="KY">KY</option>
              <option value="LA">LA</option>
              <option value="MA">MA</option>
              <option value="MD">MD</option>
              <option value="ME">ME</option>
              <option value="MI">MI</option>
              <option value="MN">MN</option>
              <option value="MO">MO</option>
              <option value="MS">MS</option>
              <option value="MT">MT</option>
              <option value="NC">NC</option>
              <option value="ND">ND</option>
              <option value="NE">NE</option>
              <option value="NH">NH</option>
              <option value="NJ">NJ</option>
              <option value="NM">NM</option>
              <option value="NV">NV</option>
              <option value="NY">NY</option>
              <option value="OH">OH</option>
              <option value="OK">OK</option>
              <option value="OR">OR</option>
              <option value="PA">PA</option>
              <option value="RI">RI</option>
              <option value="SC">SC</option>
              <option value="SD">SD</option>
              <option value="TN">TN</option>
              <option value="TX">TX</option>
              <option value="UT">UT</option>
              <option value="VA">VA</option>
              <option value="VT">VT</option>
              <option value="WA">WA</option>
              <option value="WI">WI</option>
              <option value="WV">WV</option>
              <option value="WY">WY</option>
              <option value="AS">AS</option>
              <option value="FM">FM</option>
              <option value="GU">GU</option>
              <option value="MH">MH</option>
              <option value="MP">MP</option>
              <option value="PR">PR</option>
              <option value="PW">PW</option>
              <option value="VI">VI</option>
              <option value="AA">AA</option>
              <option value="AE">AE</option>
              <option value="AP">AP</option>
            </select>
          </label></div>
        <div class="at-row at-row-solo RecipientEmailAddress"><label class="at-text   RecipientEmailAddress" id="NVContributionForm2069360-RecipientInformation-RecipientEmailAddress">Email <small>(Optional)</small><input type="email"
              autocomplete="on" pattern="^([\w!#$%&amp;'*+\-\/=?\^`\{\|\}~]+\.)*[\w!#$%&amp;'*+\-\/=?\^`\{\|\}~]+@((((([a-zA-Z0-9]{1}[a-zA-Z0-9\-]{0,62}[a-zA-Z0-9]{1})|[a-zA-Z])\.)+[a-zA-Z]{2,62})|(\d{1,3}\.){3}\d{1,3}(:\d{1,5})?)$" false=""
              title="Email" name="RecipientEmailAddress" value="" maxlength="100">
          </label></div>
        <div class="at-row at-row-solo NotificationSendDate"><label class="at-date   notificationsenddate" id="NVContributionForm2069360-RecipientInformation-NotificationSendDate"></label></div>
        <div class="at-row at-row-solo NotificationMessage"><label class="at-area   NotificationMessage" id="NVContributionForm2069360-RecipientInformation-NotificationMessage"></label></div>
      </div>
      <div class="at-row">
        <div class="at-recipient-msg" style="display: none;"><label class="at-date   notificationsenddate" id="NVContributionForm2069360-RecipientInformation-NotificationSendDate">Send Date <small>(Optional)</small><input type="text"
              title="Send Date" name="NotificationSendDate" value="" maxlength="10" size="10" class="hasDatepicker" placeholder="MM/DD/YYYY" autocomplete="off" id="dp1731455494836">
          </label><label class="at-area   NotificationMessage" id="NVContributionForm2069360-RecipientInformation-NotificationMessage">Message <small>(Optional)</small><textarea false="" title="Message" name="NotificationMessage"
              maxlength="4000"></textarea>
          </label></div>
      </div>
    </div>
  </fieldset>
  <fieldset class="at-fieldset ContactInformation hideStep" id="NVContributionForm2069360-ContactInformation" style="display: block;">
    <legend class="at-legend">Details</legend>
    <div class="at-fields">
      <div class="at-row FirstName LastName"><label class="at-text   FirstName" id="NVContributionForm2069360-ContactInformation-FirstName">First Name<input type="text" autocomplete="given-name" x-autocompletetype="given-name" required=""
            title="First Name (required)" name="FirstName" value="" maxlength="20">
        </label><label class="at-text   LastName" id="NVContributionForm2069360-ContactInformation-LastName">Last Name<input type="text" autocomplete="family-name" x-autocompletetype="surname" required="" title="Last Name (required)" name="LastName"
            value="" maxlength="25">
        </label></div>
      <div class="at-row at-row-solo DateOfBirth"><label class="at-date   dateofbirth" id="NVContributionForm2069360-ContactInformation-DateOfBirth">Date of Birth <small>(Optional)</small><input type="text" title="Date of Birth" name="DateOfBirth"
            value="" maxlength="10" size="10" class="hasDatepicker" placeholder="MM/DD/YYYY" autocomplete="off" id="dp1731455494837">
        </label></div>
      <div class="at-row at-row-solo AddressLine1"><label class="at-text   AddressLine1" id="NVContributionForm2069360-ContactInformation-AddressLine1">Street Address<input type="text" autocomplete="address-line1" x-autocompletetype="address-line1"
            required="" title="Street Address (required)" name="AddressLine1" value="" maxlength="99">
        </label></div>
      <div class="at-row PostalCode City StateProvince"><label class="at-text   PostalCode" id="NVContributionForm2069360-ContactInformation-PostalCode">Postal Code<input type="tel" autocomplete="postal-code" x-autocompletetype="postal-code"
            pattern="^\d{5}([\-]\d{4})?$" required="" title="Postal Code (required)" name="PostalCode" value="" maxlength="10">
        </label><label class="at-text   City" id="NVContributionForm2069360-ContactInformation-City">City<input type="text" autocomplete="address-level2" x-autocompletetype="locality" required="" title="City (required)" name="City" value=""
            maxlength="25">
        </label><label class="at-select StateProvince" id="NVContributionForm2069360-ContactInformation-StateProvince">State/Province<select required="" autocomplete="address-level1" x-autocompletetype="administrative-area" title="State/Province"
            name="StateProvince" class=" required" id="NVContributionForm2069360-ContactInformation-StateProvince-select">
            <option value="" disabled="">- State -</option>
            <option value="AK">AK</option>
            <option value="AL">AL</option>
            <option value="AR">AR</option>
            <option value="AZ">AZ</option>
            <option value="CA">CA</option>
            <option value="CO">CO</option>
            <option value="CT">CT</option>
            <option value="DC">DC</option>
            <option value="DE">DE</option>
            <option value="FL">FL</option>
            <option value="GA">GA</option>
            <option value="HI">HI</option>
            <option value="IA">IA</option>
            <option value="ID">ID</option>
            <option value="IL">IL</option>
            <option value="IN">IN</option>
            <option value="KS">KS</option>
            <option value="KY">KY</option>
            <option value="LA">LA</option>
            <option value="MA">MA</option>
            <option value="MD">MD</option>
            <option value="ME">ME</option>
            <option value="MI">MI</option>
            <option value="MN">MN</option>
            <option value="MO">MO</option>
            <option value="MS">MS</option>
            <option value="MT">MT</option>
            <option value="NC">NC</option>
            <option value="ND">ND</option>
            <option value="NE">NE</option>
            <option value="NH">NH</option>
            <option value="NJ">NJ</option>
            <option value="NM">NM</option>
            <option value="NV">NV</option>
            <option value="NY">NY</option>
            <option value="OH">OH</option>
            <option value="OK">OK</option>
            <option value="OR">OR</option>
            <option value="PA">PA</option>
            <option value="RI">RI</option>
            <option value="SC">SC</option>
            <option value="SD">SD</option>
            <option value="TN">TN</option>
            <option value="TX">TX</option>
            <option value="UT">UT</option>
            <option value="VA">VA</option>
            <option value="VT">VT</option>
            <option value="WA">WA</option>
            <option value="WI">WI</option>
            <option value="WV">WV</option>
            <option value="WY">WY</option>
            <option value="AS">AS</option>
            <option value="FM">FM</option>
            <option value="GU">GU</option>
            <option value="MH">MH</option>
            <option value="MP">MP</option>
            <option value="PR">PR</option>
            <option value="PW">PW</option>
            <option value="VI">VI</option>
            <option value="AA">AA</option>
            <option value="AE">AE</option>
            <option value="AP">AP</option>
          </select>
        </label></div>
      <div class="at-row EmailAddress HomePhone MobilePhone"><label class="at-text   EmailAddress" id="NVContributionForm2069360-ContactInformation-EmailAddress">Email<input type="email" autocomplete="email" x-autocompletetype="email"
            pattern="^([\w!#$%&amp;'*+\-\/=?\^`\{\|\}~]+\.)*[\w!#$%&amp;'*+\-\/=?\^`\{\|\}~]+@((((([a-zA-Z0-9]{1}[a-zA-Z0-9\-]{0,62}[a-zA-Z0-9]{1})|[a-zA-Z])\.)+[a-zA-Z]{2,62})|(\d{1,3}\.){3}\d{1,3}(:\d{1,5})?)$" required="" title="Email (required)"
            name="EmailAddress" value="" maxlength="100" placeholder="email@email.com">
        </label><label class="at-text   HomePhone" id="NVContributionForm2069360-ContactInformation-HomePhone">Home Phone <small>(Optional)</small>
          <div class="intl-tel-input iti iti--allow-dropdown">
            <div class="iti__flag-container">
              <div class="iti__selected-flag" role="combobox" aria-controls="iti-0__country-listbox" aria-owns="iti-0__country-listbox" aria-expanded="false" tabindex="0" title="United States: +1" aria-activedescendant="iti-0__item-us">
                <div class="iti__flag iti__us"></div>
                <div class="iti__arrow"></div>
              </div>
            </div><input type="tel" class="intl-phone-HomePhone" name="HomePhone" title="Home Phone" data-intl-tel-input-id="0">
          </div>
        </label><label class="at-text   MobilePhone" id="NVContributionForm2069360-ContactInformation-MobilePhone">Mobile Phone <small>(Optional)</small>
          <div class="intl-tel-input iti iti--allow-dropdown">
            <div class="iti__flag-container">
              <div class="iti__selected-flag" role="combobox" aria-controls="iti-1__country-listbox" aria-owns="iti-1__country-listbox" aria-expanded="false" tabindex="0" title="United States: +1" aria-activedescendant="iti-1__item-us">
                <div class="iti__flag iti__us"></div>
                <div class="iti__arrow"></div>
              </div>
            </div><input type="tel" class="intl-phone-MobilePhone" name="MobilePhone" title="Mobile Phone" data-intl-tel-input-id="1">
          </div>
        </label></div>
      <div class="at-row at-row-solo at-row-full YesSignMeUpForUpdatesForBinder"><label class="at-check  YesSignMeUpForUpdatesForBinder" id="NVContributionForm2069360-ContactInformation-YesSignMeUpForUpdatesForBinder"><input type="checkbox"
            checked="" name="YesSignMeUpForUpdatesForBinder"> <span class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVContributionForm2069360-ContactInformation-YesSignMeUpForUpdatesForBinder-label">I agree to receive emails
              from Planned Parenthood organizations. I may unsubscribe at any time.</span></span>
        </label></div>
      <div class="at-row "><label class="at-text   PersonalUrl" id="NVContributionForm2069360-ContactInformation-PersonalUrl"> <small>(Optional)</small><input type="text" autocomplete="on" false="" title="" name="PersonalUrl" value="" maxlength="">
        </label></div>
      <div class="at-row ">
        <div class="at-markup TrackingPixel" id="NVContributionForm2069360-ContactInformation-TrackingPixel" style="display: none;"><img alt=""
            src="https://secure.everyaction.com/v1/Track/9gUb-zPeG0O_H-ib-jKN_w2?formSessionId=92aeaf5b-ae3e-430e-9fe3-a4769e1fe32c&amp;bName=chrome&amp;dType=desktop&amp;formVersion=11/7/2024 6:42:23 PM|9/3/2024 5:36:08 PM&amp;fUrl=aHR0cHM6Ly93d3cud2VhcmVwbGFubmVkcGFyZW50aG9vZC5vcmcvYS91cmdlbnRzdXBwb3J0cHBnbnk%3D&amp;fRef="
            style="display:none"></div>
      </div>
    </div>
  </fieldset>
  <fieldset class="at-fieldset PaymentInformation hideStep" id="NVContributionForm2069360-PaymentInformation" style="display: block;">
    <legend class="at-legend">Payment</legend>
    <div class="at-row">
      <div class="at-payment-method-buttons" id="NVContributionForm2069360-PaymentInformation-PaymentMethod"></div>
    </div>
    <div class="at-fields">
      <div class="at-row "><label class="at-text at-cc-number" id="NVContributionForm2069360-PaymentInformation-Account">Card Number<div class="cc-type-wrapper vgs-loading-placeholder" style="display: none;">
            <div class="cc-type unknown"></div>
            <input type="tel" autocomplete="cc-number" title="Credit Card Number" placeholder="•••• •••• •••• ••••" readonly="true">
          </div>
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Text Content

Planned Parenthood of Greater New York
Please act now!


PPGNY WILL NEVER STOP FIGHTING FOR YOUR CARE.


BUT WE CAN'T DO THIS ALONE.

Patients are counting on us. Please give as generously as you can to help
support critical Planned Parenthood of Greater New York programs and build
capacity at our health centers.

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SHOW YOUR SUPPORT
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By clicking "Log in," I confirm that I agree with the FastAction terms of
service and privacy policy.

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SHOW YOUR SUPPORT
WITH A SINGLE CLICK

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By clicking "Sign up," I confirm that I agree with the FastAction terms of
service and privacy policy.

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Planned Parenthood of Greater New York

Planned Parenthood delivers vital reproductive health care, sex education, and
information to millions of people worldwide.

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