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aidsunited.org Open in urlscan Pro
35.202.39.121  Public Scan

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Submitted URL: http://url4964.aidsunited.org/ls/click?upn=Fzl9kMYDRDb1wdDW0VurmRrxpyJdtmf365RBlB8cquEeJeB1Leu5ceIwv5w9k8PItwKsI3d36PyeOjorY2F...
Effective URL: https://aidsunited.org/harm-reduction-futures-fund-campaign/?engageddonorid=ec357abe-1e15-4edf-9a70-ccfadcf0ac63&utm_me...
Submission Tags: falconsandbox
Submission: On July 24 via api from US — Scanned from DE

Form analysis 3 forms found in the DOM

POST https://secure.engageddonor.com/form.ashx?id=134&url=https%3a%2f%2faidsunited.org%2fharm-reduction-futures-fund-campaign%2f%3fengageddonorid%3dec357abe-1e15-4edf-9a70-ccfadcf0ac63%26utm_medium%3dEmail%26utm_campaign%3dwebsite%26utm_source%3dSumma&c=3c6c4007-dd79-4fa2-9029-ce596895092d

<form id="benforminput" method="post" enctype="multipart/form-data"
  action="https://secure.engageddonor.com/form.ashx?id=134&amp;url=https%3a%2f%2faidsunited.org%2fharm-reduction-futures-fund-campaign%2f%3fengageddonorid%3dec357abe-1e15-4edf-9a70-ccfadcf0ac63%26utm_medium%3dEmail%26utm_campaign%3dwebsite%26utm_source%3dSumma&amp;c=3c6c4007-dd79-4fa2-9029-ce596895092d"
  novalidate="novalidate">
  <div id="concntrl325" class="benformelement benformcon">
    <div class="bentableheading">Personal Information</div>
    <div class="bentable form benmobile">
      <div id="concntrl325_ctl00_benrow">
        <div>
          <span id="concntrl325_ctl00_lbl" class="ben_name">First Name</span>
          <span class="required">*</span>
        </div>
        <div>
          <input name="concntrl325$ctl00$txt" type="text" id="concntrl325_ctl00_txt" bfirstname="" onchange="benPrepopHonorRollName();" class="ben_name" autocomplete="given-name" required="required" req="">
        </div>
      </div>
      <div id="concntrl325_ctl01_benrow">
        <div>
          <span id="concntrl325_ctl01_lbl" class="ben_name">Last Name</span>
          <span class="required">*</span>
        </div>
        <div>
          <input name="concntrl325$ctl01$txt" type="text" id="concntrl325_ctl01_txt" blastname="" onchange="benPrepopHonorRollName();" class="ben_name" autocomplete="family-name" required="required" req="">
        </div>
      </div>
      <div id="concntrl325_ctl02_benrow">
        <div>
          <span id="concntrl325_ctl02_lbl">Email</span>
          <span class="required">*</span>
        </div>
        <div>
          <input name="concntrl325$ctl02$txt" type="text" id="concntrl325_ctl02_txt" class="ben_email" autocomplete="email" required="">
        </div>
      </div>
      <div id="ctl03_benrow">
        <div>
          <span id="ctl03_lbl">Phone</span>
          <span class="required">*</span>
        </div>
        <div>
          <input name="concntrl325$ctl03$txt" type="text" id="ctl03_txt" autocomplete="tel" required="">
          <script type="text/javascript">
            jB('#ctl03_txt').mask('(999) 999-9999? x99999');
          </script>
        </div>
      </div>
      <div id="concntrl325_ctl04_benrow">
        <div>
          <span id="concntrl325_ctl04_lbl">Address Line 1</span>
          <span class="required">*</span>
        </div>
        <div>
          <input name="concntrl325$ctl04$txt" type="text" id="concntrl325_ctl04_txt" autocomplete="address-line1" required="">
        </div>
      </div>
      <div id="concntrl325_ctl05_benrow">
        <div>
          <span id="concntrl325_ctl05_lbl">City</span>
          <span class="required">*</span>
        </div>
        <div>
          <input name="concntrl325$ctl05$txt" type="text" id="concntrl325_ctl05_txt" required="">
        </div>
      </div>
      <div id="concntrl325_ctl06_benrow">
        <div>
          <span id="concntrl325_ctl06_lbl">Province/State</span>
          <span class="required">*</span>
        </div>
        <div>
          <select name="concntrl325$ctl06$ddlState" id="concntrl325_ctl06_ddlState" class="dropdown ben_state" rftid="1" required="">
            <option value=""></option>
            <option value="AL">AL</option>
            <option value="AK">AK</option>
            <option value="AZ">AZ</option>
            <option value="AR">AR</option>
            <option value="CA">CA</option>
            <option value="CO">CO</option>
            <option value="CT">CT</option>
            <option value="DE">DE</option>
            <option value="DC">DC</option>
            <option value="FL">FL</option>
            <option value="GA">GA</option>
            <option value="GU">GU</option>
            <option value="HI">HI</option>
            <option value="ID">ID</option>
            <option value="IL">IL</option>
            <option value="IN">IN</option>
            <option value="IA">IA</option>
            <option value="KS">KS</option>
            <option value="KY">KY</option>
            <option value="LA">LA</option>
            <option value="ME">ME</option>
            <option value="MD">MD</option>
            <option value="MA">MA</option>
            <option value="MI">MI</option>
            <option value="MN">MN</option>
            <option value="MS">MS</option>
            <option value="MO">MO</option>
            <option value="MT">MT</option>
            <option value="NE">NE</option>
            <option value="NV">NV</option>
            <option value="NH">NH</option>
            <option value="NJ">NJ</option>
            <option value="NM">NM</option>
            <option value="NY">NY</option>
            <option value="NC">NC</option>
            <option value="ND">ND</option>
            <option value="OH">OH</option>
            <option value="OK">OK</option>
            <option value="OR">OR</option>
            <option value="PA">PA</option>
            <option value="PR">PR</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="VT">VT</option>
            <option value="VA">VA</option>
            <option value="WA">WA</option>
            <option value="WV">WV</option>
            <option value="WI">WI</option>
            <option value="WY">WY</option>
          </select>
          <script type="text/javascript">
            benLoadStates('1');
          </script>
        </div>
      </div>
      <div id="concntrl325_ctl07_benrow">
        <div>
          <span id="concntrl325_ctl07_lbl">Postal Code</span>
          <span class="required">*</span>
        </div>
        <div>
          <input name="concntrl325$ctl07$txt" type="text" id="concntrl325_ctl07_txt" autocomplete="postal-code" required="">
        </div>
      </div>
    </div>
  </div>
  <div id="doncntrl326" class="benformelement benformdon">
    <div style="margin: 10px 0px;">
      <script type="text/javascript">
      </script>
      <div class="heading3" style="display: none;"> Harm Reduction Futures Fund </div>
      <div class="bentableheading"> Donation</div>
      <div>
        <table id="rblLevels" class="bendonlevels" style="font-size:13px;font-weight:bold;">
          <tbody>
            <tr>
              <td><input id="rblLevels_0" type="radio" name="doncntrl326$rblLevels" value="500" onclick="jQuery('#ben_DonationAmount').val(jQuery(this).val());updatePaymentTotalsNew(this);"><label for="rblLevels_0">$500</label></td>
              <td><input id="rblLevels_1" type="radio" name="doncntrl326$rblLevels" value="100" onclick="jQuery('#ben_DonationAmount').val(jQuery(this).val());updatePaymentTotalsNew(this);"><label for="rblLevels_1">$100</label></td>
              <td><input id="rblLevels_2" type="radio" name="doncntrl326$rblLevels" value="25" onclick="jQuery('#ben_DonationAmount').val(jQuery(this).val());updatePaymentTotalsNew(this);"><label for="rblLevels_2">$25</label></td>
              <td><input id="rblLevels_3" type="radio" name="doncntrl326$rblLevels" value="75" onclick="jQuery('#ben_DonationAmount').val(jQuery(this).val());updatePaymentTotalsNew(this);"><label for="rblLevels_3">$75</label></td>
              <td><input id="rblLevels_4" type="radio" name="doncntrl326$rblLevels" value="50" onclick="jQuery('#ben_DonationAmount').val(jQuery(this).val());updatePaymentTotalsNew(this);"><label for="rblLevels_4">$50</label></td>
              <td><input id="rblLevels_5" type="radio" name="doncntrl326$rblLevels" value="0"><label for="rblLevels_5">Other</label></td>
            </tr>
          </tbody>
        </table>
      </div>
      <div class="bentable form benmobile">
        <div>
          <div>Donation Amount:</div>
          <div style="position: relative;">
            <div style="position: absolute; left: -5px; top: 2px; display: none;">$</div>
            <input name="doncntrl326$ben_DonationAmount" type="text" autocomplete="off" id="ben_DonationAmount" class="benformdonationamount" minimum="0"
              onchange="updatePaymentTotalsNew(this); jB('#rblLevels input[type=radio]').prop('checked', ''); jB('#rblLevels input[value=0]').prop('checked', true);"
              onkeyup="updatePaymentTotalsNew(this); jB('#rblLevels input[type=radio]').prop('checked', ''); jB('#rblLevels input[value=0]').prop('checked', true);">
            <input type="hidden" name="doncntrl326$ben_hdfDonationOverride" id="doncntrl326_ben_hdfDonationOverride">
          </div>
        </div>
      </div>
      <div class="benrecurring">
        <div style="margin-top: 8px;">
          <input name="doncntrl326$cbxRecurring" type="checkbox" id="doncntrl326_cbxRecurring" onchange="var r='none'; if (jQuery(this).prop('checked')){r='';} jQuery('#recurringdiv').css('display',r); updatePaymentTotalsNew(this);">
          <label for="doncntrl326_cbxRecurring" style="font-size: 18px;">Make this a recurring gift</label>
        </div>
        <div>Your gift will automatically repeat until you decide to cancel it.</div>
        <div id="recurringdiv" class="table form" style="margin-top: 4px;">
          <table id="doncntrl326_rblRecurring" onchange="updatePaymentTotalsNew(this);">
            <tbody>
              <tr>
                <td><input id="doncntrl326_rblRecurring_0" type="radio" name="doncntrl326$rblRecurring" value="Weekly"><label for="doncntrl326_rblRecurring_0">Weekly</label></td>
                <td><input id="doncntrl326_rblRecurring_1" type="radio" name="doncntrl326$rblRecurring" value="Monthly"><label for="doncntrl326_rblRecurring_1">Monthly</label></td>
                <td><input id="doncntrl326_rblRecurring_2" type="radio" name="doncntrl326$rblRecurring" value="Quarterly"><label for="doncntrl326_rblRecurring_2">Quarterly</label></td>
                <td><input id="doncntrl326_rblRecurring_3" type="radio" name="doncntrl326$rblRecurring" value="Annually"><label for="doncntrl326_rblRecurring_3">Annually</label></td>
              </tr>
            </tbody>
          </table>
        </div>
      </div>
      <div class="bentable form benmobile">
        <div id="doncntrl326_46" class="benfield " style="display:none;">
          <div>
            <span id="doncntrl326_46_lbl">I wish to cover the credit card processing fee</span>
            <span id="doncntrl326_46_rfcfee" class="rfcfee"> - $0.75</span>
          </div>
          <div>
            <input name="doncntrl326$46$46_cbxprocessingfee" type="checkbox" id="doncntrl326_46_46_cbxprocessingfee" fieldtype="9" defaultvalue="" fieldid="46" maxquantity="0" fee="0" showquantity="0" onchange="updateConditionsNew(this);" rdfid="0"
              checked="checked">
          </div>
          <div>
            <span class="benfieldquantitylabel" style="display: none;">Quantity: </span>
            <select name="doncntrl326$46$ddlQuantity" id="doncntrl326_46_ddlQuantity" class="benfieldquantity" onchange="updateConditionsNew(this);" style="display: none;">
            </select>
          </div>
        </div>
      </div>
    </div>
  </div>
  <div id="paymentcntrl_benformpayment" class="benformpayment" style="margin: 10px 0px;">
    <div class="bentableheading">Payment Information</div>
    <div id="benpaymentcreditcard">
      <style type="text/css">
        .bluesnappaymentoption {
          text-align: center;
        }

        .bspayoptionitem {
          padding: 5px 10px;
          margin: 8px;
          border: 2px #999 solid;
          border-radius: 10px;
          cursor: pointer;
          background-color: #e2e2e2;
          min-width: 86px;
        }

        .bluesnappaymentoption .far {
          font-size: 60px;
          color: #777;
          font-weight: bold;
        }

        .bspayoptionitem:hover .far,
        .bspayoptionitem:hover span {
          color: #444;
        }

        .bspayoptionitem.active .far,
        .bspayoptionitem.active span {
          color: #222;
        }

        .bspayoptionitem.active {
          background-color: white;
        }

        .bluesnappaymentoption span {
          display: block;
          font-weight: bold;
          font-size: 12px;
          color: #777;
        }

        .benbsachwrap input[type=checkbox] {
          margin: 8px;
        }
      </style>
      <div id="benbsccwrap">
        <div class="benbspaymentswrap">
          <div class="bentable">
            <div>
              <div data-bluesnap="ccn"><iframe id="bluesnap-hosted-iframe-ccn" src="https://www1.bluesnap.com/web-sdk/4.12.5/hpfCcnInput.html" name="aHR0cHM6Ly9haWRzdW5pdGVkLm9yZw==" role="presentation" frameborder="0" scrolling="no"
                  style="border: none; width: 100%; height: 100%; float: left; background: transparent;"></iframe></div>
              <div style="width: 10px;"></div>
              <div data-bluesnap="exp" style="width: 25%;"><iframe id="bluesnap-hosted-iframe-exp" src="https://www1.bluesnap.com/web-sdk/4.12.5/hpfExpInput.html" name="aHR0cHM6Ly9haWRzdW5pdGVkLm9yZw==" role="presentation" frameborder="0"
                  scrolling="no" style="border: none; width: 100%; height: 100%; float: left; background: transparent;"></iframe></div>
              <div style="width: 10px;"></div>
              <div data-bluesnap="cvv" style="width: 25%;"><iframe id="bluesnap-hosted-iframe-cvv" src="https://www1.bluesnap.com/web-sdk/4.12.5/hpfCvvInput.html" name="aHR0cHM6Ly9haWRzdW5pdGVkLm9yZw==" role="presentation" frameborder="0"
                  scrolling="no" style="border: none; width: 100%; height: 100%; float: left; background: transparent;"></iframe></div>
            </div>
          </div>
          <div data-bluesnap="walletButton" style="height: auto; margin-top: 10px;"><iframe id="walletButtonIframe" src="https://www1.bluesnap.com/web-sdk/4.12.5/walletButton.html" name="aHR0cHM6Ly9haWRzdW5pdGVkLm9yZw==" role="presentation"
              frameborder="0" scrolling="no" allowpaymentrequest="true" allow="payment" style="display: none; width: 100%; height: 48px;"></iframe></div>
        </div>
        <div class="benbspaymentsuccess table" style="display: none;">
          <div>
            <div><i class="fa fa-check-square" style="margin: 20px 0px; color: green; font-size: 40px;"></i></div>
            <div style="vertical-align: middle; font-size: 20px; padding-left: 14px;">Your payment method has been selected</div>
          </div>
        </div>
      </div>
      <div id="benbsachwrap" class="benbsachwrap" style="display: none; border: solid 2px gray; border-radius: 10px; padding: 10px;">
        <div class="bentable form">
          <div>
            <div> Account Holder's First Name </div>
            <div>
              <input name="paymentcntrl$txtBSACHFirstName" type="text" id="paymentcntrl_txtBSACHFirstName" placeholder="First Name">
            </div>
          </div>
          <div>
            <div> Account Holder's Last Name </div>
            <div>
              <input name="paymentcntrl$txtBSACHLastName" type="text" id="paymentcntrl_txtBSACHLastName" placeholder="Last Name">
            </div>
          </div>
          <div>
            <div> Routing Number </div>
            <div>
              <input id="ecpRoutingNumber" type="text" name="ecpRoutingNumber" data-bluesnap="ecpRoutingNumber" placeholder="Routing Number" autocompletetype="new-text">
            </div>
          </div>
          <div>
            <div> Account Number </div>
            <div>
              <input id="ecpAccountNumber" type="text" name="ecpAccountNumber" data-bluesnap="ecpAccountNumber" placeholder="Account Number" autocompletetype="new-text">
            </div>
          </div>
          <div>
            <div> Account Type </div>
            <div>
              <select id="ecpAccountTypeSelect" onchange="jB('#ecpAccountType').val(jB(this).val());">
                <option value="CONSUMER_CHECKING">Personal Checking</option>
                <option value="CONSUMER_SAVINGS">Personal Savings</option>
                <option value="CORPORATE_CHECKING">Corporate Checking</option>
                <option value="CORPORATE_SAVINGS">Corporate Savings</option>
              </select>
              <input id="ecpAccountType" type="text" name="ecpAccountType" data-bluesnap="ecpAccountType" placeholder="Account Type" value="CONSUMER_CHECKING" style="display: none; visibility: hidden;">
            </div>
          </div>
        </div>
        <div style="padding: 8px;">
          <span style="font-weight:bold;"><input id="paymentcntrl_cbxBSACHAuthorize" type="checkbox" name="paymentcntrl$cbxBSACHAuthorize"><label for="paymentcntrl_cbxBSACHAuthorize">I authorize this Electronic Check (ACH/ECP) transaction and agree
              to this debit of my account.</label></span>
        </div>
      </div>
      <input type="hidden" name="paymentcntrl$hdfBlueSnapToken" id="paymentcntrl_hdfBlueSnapToken"
        value="eyJhbGciOiJIUzI1NiJ9.eyJwYXlsb2FkIjp7ImNvbW1vbkp3dFBheWxvYWQiOnsiaWQiOiIyNTAxNjkwMjY0NjkzNjM4Mzc3ODAwOSIsImRhdGVDcmVhdGVkIjoxNjkwMjA0NDkwNjk2fSwibWVyY2hhbnRJZCI6MTI5NTk0MCwic2VudHJ5Ijp7Im1lcmNoYW50IjpmYWxzZSwiYXBwcyI6W119fX0.pBjMx8tM4rIJrI7aEdP4VEuYTAUnmKJWMuF4bSOJB1Q._1"><input
        type="hidden" name="paymentcntrl$hdfbenMobilePay" id="paymentcntrl_hdfbenMobilePay"><input type="hidden" name="paymentcntrl$hdfbenBSPaymentType" id="paymentcntrl_hdfbenBSPaymentType">
      <script type="text/javascript">
        benLoadBlueSnapPayment('benforminput',
          'eyJhbGciOiJIUzI1NiJ9.eyJwYXlsb2FkIjp7ImNvbW1vbkp3dFBheWxvYWQiOnsiaWQiOiIyNTAxNjkwMjY0NjkzNjM4Mzc3ODAwOSIsImRhdGVDcmVhdGVkIjoxNjkwMjA0NDkwNjk2fSwibWVyY2hhbnRJZCI6MTI5NTk0MCwic2VudHJ5Ijp7Im1lcmNoYW50IjpmYWxzZSwiYXBwcyI6W119fX0.pBjMx8tM4rIJrI7aEdP4VEuYTAUnmKJWMuF4bSOJB1Q._1'
          );
      </script>
      <div style="margin: 8px 0px;">
        <input id="paymentcntrl_cbxSavePaymentMethod" type="checkbox" name="paymentcntrl$cbxSavePaymentMethod"><label for="paymentcntrl_cbxSavePaymentMethod">Securely store my credit card information for future use</label>
      </div>
      <div class="bentableheading" style="display: none;">Billing Information</div>
      <div class="" style="display: none;">
        <div>
          <div>Address Line 1:</div>
          <div>
            <input name="paymentcntrl$ben_billingaddressline1" type="text" id="paymentcntrl_ben_billingaddressline1" class="textbox">
          </div>
        </div>
        <div>
          <div>City:</div>
          <div>
            <input name="paymentcntrl$ben_billingcity" type="text" id="paymentcntrl_ben_billingcity" class="textbox">
          </div>
        </div>
        <div>
          <div>State:</div>
          <div>
            <select name="paymentcntrl$ben_billingstate" id="paymentcntrl_ben_billingstate" class="dropdown">
              <option value=""></option>
              <option value="AL">AL</option>
              <option value="AK">AK</option>
              <option value="AZ">AZ</option>
              <option value="AR">AR</option>
              <option value="CA">CA</option>
              <option value="CO">CO</option>
              <option value="CT">CT</option>
              <option value="DE">DE</option>
              <option value="DC">DC</option>
              <option value="FL">FL</option>
              <option value="GA">GA</option>
              <option value="HI">HI</option>
              <option value="ID">ID</option>
              <option value="IL">IL</option>
              <option value="IN">IN</option>
              <option value="IA">IA</option>
              <option value="KS">KS</option>
              <option value="KY">KY</option>
              <option value="LA">LA</option>
              <option value="ME">ME</option>
              <option value="MD">MD</option>
              <option value="MA">MA</option>
              <option value="MI">MI</option>
              <option value="MN">MN</option>
              <option value="MS">MS</option>
              <option value="MO">MO</option>
              <option value="MT">MT</option>
              <option value="NE">NE</option>
              <option value="NV">NV</option>
              <option value="NH">NH</option>
              <option value="NJ">NJ</option>
              <option value="NM">NM</option>
              <option value="NY">NY</option>
              <option value="NC">NC</option>
              <option value="ND">ND</option>
              <option value="OH">OH</option>
              <option value="OK">OK</option>
              <option value="OR">OR</option>
              <option value="PA">PA</option>
              <option value="PR">PR</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="VT">VT</option>
              <option value="VA">VA</option>
              <option value="WA">WA</option>
              <option value="WV">WV</option>
              <option value="WI">WI</option>
              <option value="WY">WY</option>
            </select>
          </div>
        </div>
        <div>
          <div>Province:</div>
          <div>
            <input name="paymentcntrl$ben_billingprovince" type="text" id="paymentcntrl_ben_billingprovince" class="textbox">
          </div>
        </div>
        <div>
          <div>Zip/Postal Code:</div>
          <div>
            <input name="paymentcntrl$ben_billingzipcode" type="text" id="paymentcntrl_ben_billingzipcode" class="textbox">
          </div>
        </div>
      </div>
      <div id="paymentcntrl_pnlLogInButton" style="margin: 8px 0px;">
        <a href="javascript: void(0);" onclick="benShowPopup('beninlinelogin');">Sign in to select saved payment methods</a>
      </div>
    </div>
    <div id="benpaymentwallet" style="display: none; padding: 10px 0px;">
      <select name="paymentcntrl$ddlWalletCards" id="paymentcntrl_ddlWalletCards" class="benddlpaymentwallet">
        <option value="">Select a card</option>
      </select>
      <span class="required" aria-required="true">*</span>
      <div style="padding-top: 10px;">
        <a href="javascript: void(0);" onclick="jB('#benpaymentwallet').hide();jB('#benpaymentcreditcard').show();jB('.benddlpaymentwallet').val('0');jB('.benddlpaymentwallet').rules('remove', 'required');jB('.benddlpaymentwallet').val('');">Enter a new credit card number</a>
      </div>
    </div>
    <div id="beninlinelogin" style="visibility: hidden;" class="hideshow">
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Name: New Form — POST 

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POST /p2p/login.ashx?rd=

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HARM REDUCTION FUTURES FUND


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Personal Information
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ALAKAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPAPRRISCSDTNTXUTVTVAWAWVWIWY
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Harm Reduction Futures Fund
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I wish to cover the credit card processing fee - $0.75

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I wish to cover the credit card processing fee - $0.75
Total: $25.75
  

The Harm Reduction Futures Fund strengthens the lifesaving work of syringe
services programs across the country. Its mission remains the same as it was
nearly two decades ago: to reduce the health, psychosocial and socioeconomic
disparities experienced by people who use drugs. To that end, the fund invests
in evidence-based and community-driven approaches to prevent the transmission of
both HIV and viral hepatitis, reduce injection-related injuries, increase
overdose prevention and reversal efforts and connect people who use drugs to
comprehensive prevention, treatment, and support services.

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