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Submitted URL: https://sqclick.com/outreach/t/hY6vXVzUef4A/https%253A%252F%252Fform.jotform.com%252F241193308887162%253Futm_source%...
Effective URL: https://form.jotform.com/241193308887162?utm_source=sqmktg_email
Submission: On May 01 via api from NL — Scanned from NL
Effective URL: https://form.jotform.com/241193308887162?utm_source=sqmktg_email
Submission: On May 01 via api from NL — Scanned from NL
Form analysis 1 forms found in the DOM
Name: form_241193308887162 — POST https://submit.jotform.com/submit/241193308887162
<form class="jotform-form" onsubmit="return typeof testSubmitFunction !== 'undefined' && testSubmitFunction();" action="https://submit.jotform.com/submit/241193308887162" method="post" name="form_241193308887162" id="241193308887162"
accept-charset="utf-8" autocomplete="on" novalidate="true"><input type="hidden" name="formID" value="241193308887162"><input type="hidden" id="JWTContainer" value=""><input type="hidden" id="cardinalOrderNumber" value=""><input type="hidden"
id="jsExecutionTracker" name="jsExecutionTracker" value="build-date-1714479486611=>init-started:1714573302495=>validator-called:1714573302501=>validator-mounted-true:1714573302501=>init-complete:1714573302505"><input type="hidden"
id="submitSource" name="submitSource" value="mounted"><input type="hidden" id="buildDate" name="buildDate" value="1714479486611">
<div id="formCoverLogo" style="margin-bottom:32px" class="form-cover-wrapper form-has-cover form-page-cover-image-align-center">
<div class="form-page-cover-image-wrapper" style="max-width:670px"><img src="https://www.jotform.com/uploads/Lee_Brandon/form_files/redleaf-logo-transparetnback-512.6361c2e56bc2b2.02532599.png" class="form-page-cover-image" width="410"
aria-label="Form Logo" style="aspect-ratio:410/141"></div>
</div>
<div role="main" class="form-all">
<ul class="form-section page-section">
<li class="form-line" data-type="control_image" id="id_36">
<div id="cid_36" class="form-input-wide">
<div style="text-align:center" aria-hidden="true" role="none"><img alt="Image-36" loading="lazy" class="form-image" style="border:0" src="https://www.jotform.com/uploads/Lee_Brandon/form_files/IMG_8890_jpg.662f996da2acb7.16165306.JPG"
height="664px" width="598px" data-component="image" role="none" aria-hidden="true" tabindex="-1"></div>
</div>
</li>
<li id="cid_32" class="form-input-wide" data-type="control_head">
<div class="form-header-group header-large">
<div class="header-text httal htvam">
<h1 id="header_32" class="form-header" data-component="header">Mother's Day Box</h1>
<div id="subHeader_32" class="form-subHeader">$20 gift card, Cake Pop, 16oz Drink, Small assorted flowers</div>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_textbox" id="id_3"><label class="form-label form-label-left form-label-auto" id="label_3" for="input_3" aria-hidden="false"> Name<span class="form-required">*</span> </label>
<div id="cid_3" class="form-input jf-required"> <input type="text" id="input_3" name="q3_name" data-type="input-textbox" class="form-textbox validate[required]" data-defaultvalue="" size="25" placeholder=" " data-component="textbox"
aria-labelledby="label_3" required="" value=""> </div>
</li>
<li class="form-line jf-required" data-type="control_email" id="id_35"><label class="form-label form-label-left form-label-auto" id="label_35" for="input_35" aria-hidden="false"> E-mail<span class="form-required">*</span> </label>
<div id="cid_35" class="form-input jf-required"> <input type="email" id="input_35" name="q35_email" class="form-textbox validate[required, Email]" data-defaultvalue="" autocomplete="section-input_35 email" size="30"
placeholder="ex: myname@example.com" data-component="email" aria-labelledby="label_35" required="" value=""> </div>
</li>
<li class="form-line jf-required" data-type="control_phone" id="id_34"><label class="form-label form-label-left form-label-auto" id="label_34" for="input_34_area" aria-hidden="false"> Contact Number<span class="form-required">*</span> </label>
<div id="cid_34" class="form-input jf-required">
<div data-wrapper-react="true"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="areaCode"><input type="tel" id="input_34_area" name="q34_contactNumber[area]" class="form-textbox validate[required]"
data-defaultvalue="" autocomplete="section-input_34 tel-area-code" data-component="areaCode" aria-labelledby="label_34 sublabel_34_area" required="" value=""><span class="phone-separate" aria-hidden="true"> -</span><label
class="form-sub-label" for="input_34_area" id="sublabel_34_area" style="min-height:13px">Area Code</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="phone"><input type="tel"
id="input_34_phone" name="q34_contactNumber[phone]" class="form-textbox validate[required]" data-defaultvalue="" autocomplete="section-input_34 tel-local" data-component="phone" aria-labelledby="label_34 sublabel_34_phone" required=""
value=""><label class="form-sub-label" for="input_34_phone" id="sublabel_34_phone" style="min-height:13px">Phone Number</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_dropdown" id="id_25"><label class="form-label form-label-left form-label-auto" id="label_25" for="input_25" aria-hidden="false"> Pickup Location<span class="form-required">*</span> </label>
<div id="cid_25" class="form-input jf-required"> <select class="form-dropdown validate[required]" id="input_25" name="q25_servingSize" style="width:150px" data-component="dropdown" required="" aria-label="Pickup Location">
<option value="">Please Select</option>
<option value="Kelso - 209 W. Main St">Kelso - 209 W. Main St</option>
<option value="Longivew - 3202 Ocean Beach Hwy">Longivew - 3202 Ocean Beach Hwy</option>
<option value="Woodland - 1494 Dike Access Road">Woodland - 1494 Dike Access Road</option>
<option value=""></option>
</select> </div>
</li>
<li class="form-line jf-required" data-type="control_textbox" id="id_37"><label class="form-label form-label-left form-label-auto" id="label_37" for="input_37" aria-hidden="false"> 16oz Drink<span class="form-required">*</span> </label>
<div id="cid_37" class="form-input jf-required"> <input type="text" id="input_37" name="q37_16ozDrink" data-type="input-textbox" class="form-textbox validate[required]" data-defaultvalue="" size="20" data-component="textbox"
aria-labelledby="label_37" required="" value=""> </div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_39"><label class="form-label form-label-left form-label-auto" id="label_39" aria-hidden="false"> Cake Pop Flavor<span class="form-required">*</span> </label>
<div id="cid_39" class="form-input jf-required">
<div class="form-single-column" role="group" aria-labelledby="label_39" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_39"
class="form-radio validate[required]" id="input_39_0" name="q39_cakePop" value="White Chocolate Caramel" required=""><label id="label_input_39_0" for="input_39_0">White Chocolate Caramel</label></span><span class="form-radio-item"
style="clear:left"><span class="dragger-item"></span><input type="radio" aria-describedby="label_39" class="form-radio validate[required]" id="input_39_1" name="q39_cakePop" value="Rocky Mountain" required=""><label
id="label_input_39_1" for="input_39_1">Rocky Mountain</label></span></div>
</div>
</li>
<li class="form-line" data-type="control_textarea" id="id_6"><label class="form-label form-label-left form-label-auto" id="label_6" for="input_6" aria-hidden="false"> Additional Info </label>
<div id="cid_6" class="form-input"> <textarea id="input_6" class="form-textarea" name="q6_additionalInfo" cols="25" rows="6" data-component="textarea" aria-labelledby="label_6"></textarea> </div>
</li>
<li class="form-line" data-type="control_square" id="id_38" data-payment="true"><label class="form-label form-label-left form-label-auto" id="label_38" for="input_38" aria-hidden="false"> Mother's Day Box </label>
<div id="cid_38" class="form-input">
<div data-wrapper-react="true" class="square-payment-wrapper" data-square-currency="USD">
<div data-wrapper-react="true" class="product-container-wrapper">
<div class="filter-container"></div><input type="hidden" name="simple_fpc" data-payment_type="square" data-component="payment1" value="38"><input type="hidden" name="payment_transaction_uuid" id="paymentTransactionId"
value="018f34885b8a7472a3436b6e7a4d23f05206"><input type="hidden" name="payment_version" id="payment_version" value="4"><input type="hidden" name="payment_total_checksum" id="payment_total_checksum" data-component="payment2"><input
type="hidden" name="payment_discount_value" id="payment_discount_value" data-component="payment3">
<div id="image-overlay" class="overlay-content" style="display:none"><img id="current-image"><span class="lb-prev-button">prev</span><span class="lb-next-button">next</span><span class="lb-close-button">( X )</span><span
class="image-overlay-product-container">
<ul class="form-overlay-item" pid="1000" hasicon="false" hasimages="true" iconvalue="">
<li class="image-overlay-image"><img loading="lazy" src="https://www.jotform.com/uploads/Lee_Brandon/form_files/IMG_8890_jpg.662f996da2acb7.16165306.JPG"></li>
</ul>
<ul class="form-overlay-item" pid="1001" hasicon="false" hasimages="false" iconvalue=""></ul>
</span></div>
<div data-wrapper-react="true"><span class="form-product-item hover-product-item" categories="non-categorized" pid="1000"><img loading="lazy"
src="https://www.jotform.com/uploads/Lee_Brandon/form_files/IMG_8890_jpg.662f996da2acb7.16165306.JPG" alt="product" class="form-product-image-with-options" width="50" style="height:auto;vertical-align:middle">
<div data-wrapper-react="true" class="form-product-item-detail"><input type="checkbox" class="form-checkbox form-product-input" id="input_38_1000" name="q38_myProducts[][id]" value="1000" checked="" disabled="" required=""
data-is-default-required="true" data-is-default-selected="true" aria-label="Select Product: Mother's Day Box"><label for="input_38_1000" class="form-product-container"><span data-wrapper-react="true"><span
class="form-product-name" id="product-name-input_38_1000">Mother's Day Box</span><span class="form-product-details"><b><span data-wrapper-react="true">$<span id="input_38_1000_price">35.00</span></span></b></span></span>
<div class="form-product-description" id="product-name-description-input_38_1000">Includes $20 Red Leaf Organic Coffee gift card, Cake Pop, 16oz drink and small assortment of flowers in a Red Leaf Coffee cup.</div>
</label></div>
</span><br><span class="form-product-item hover-product-item " categories="non-categorized" pid="1001">
<div data-wrapper-react="true" class="form-product-item-detail"><input type="checkbox" class="form-checkbox form-product-input" id="input_38_1001" name="q38_myProducts[][id]" value="1001" data-is-default-required="false"
data-is-default-selected="false" aria-label="Select Product: Additional Gift Card"><label for="input_38_1001" class="form-product-container"><span data-wrapper-react="true"><span class="form-product-name"
id="product-name-input_38_1001">Additional Gift Card</span><span class="form-product-details"><b><span data-wrapper-react="true">$<span id="input_38_1001_price">10.00</span></span></b></span></span>
<div class="form-product-description" id="product-name-description-input_38_1001"></div>
</label><br><br><span class="form-sub-label-container" style="vertical-align:top"><label class="form-sub-label" for="input_38_custom_1001_0" style="min-height:13px">Denomination</label><select class="form-dropdown"
name="q38_myProducts[special_1001][item_0]" id="input_38_custom_1001_0">
<option value="$10">$10</option>
<option value="$20">$20</option>
<option value="$30">$30</option>
<option value="$40">$40</option>
<option value="$50">$50</option>
</select></span></div>
</span><br><span class="form-payment-total"><b><span id="total-text">Total</span> <span class="form-payment-price"><span data-wrapper-react="true">$<span id="payment_total">35.00</span></span></span></b></span></div>
<hr>
</div>
<h4 class="payment-methods-header">Credit Card</h4>
<table style="margin:0px" id="square-creditcard" class="form-address-table payment-form-table square-cc-field" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td width="50%"><input type="text" id="input_38_cc_firstName" name="q38_myProducts[cc_firstName]" class="form-textbox cc_firstName" data-defaultvalue="" size="20" placeholder="First Name" data-component="cc_firstName"
aria-label="Credit Card First Name" aria-labelledby="" value="" maxlength="60"></td>
<td width="50%"><input type="text" id="input_38_cc_lastName" name="q38_myProducts[cc_lastName]" class="form-textbox cc_lastName" data-defaultvalue="" size="20" placeholder="Last Name" data-component="cc_lastName"
aria-label="Credit Card Last Name" aria-labelledby="" value="" maxlength="60"></td>
</tr>
<tr class="if_cc_field">
<td colspan="2" width="100%">
</td>
</tr>
<tr class="if_cc_field">
<td colspan="2">
<div id="card-container">
<div id="single-card-wrapper-92f1cce1-5a57-7964-c24b-20abc7e7ec57" class="sq-card-wrapper">
<div class="sq-card-iframe-container" style="height: 97px;"><iframe frameborder="0" height="97px" name="single-card-92f1cce1-5a57-7964-c24b-20abc7e7ec57" scrolling="no"
src="https://web.squarecdn.com/1.55.1/single-card-element-iframe.html" width="100%" class="sq-card-component"></iframe></div><span class="sq-card-message"></span>
</div>
</div>
</td>
</tr>
</tbody>
</table>
<div id="square_dummy" data-sandbox="false"></div>
</div>
</div>
</li>
<li class="form-line" data-type="control_button" id="id_19">
<div id="cid_19" class="form-input-wide">
<div data-align="left" class="form-buttons-wrapper form-buttons-left jsTest-button-wrapperField"><button id="input_19" type="submit"
class="form-submit-button form-submit-button-simple_black submit-button jf-form-buttons jsTest-submitField" data-component="button" data-content="" aria-live="polite">Place Order</button></div>
</div>
</li>
<li style="display:none">Should be Empty: <input type="text" name="website" value=""></li>
</ul>
</div>
<script>
JotForm.showJotFormPowered = "0";
</script>
<script>
JotForm.poweredByText = "Powered by Jotform";
</script><input type="hidden" class="simple_spc" id="simple_spc" name="simple_spc" value="241193308887162-241193308887162">
<script type="text/javascript">
var all_spc = document.querySelectorAll("form[id='241193308887162'] .si" + "mple" + "_spc");
for (var i = 0; i < all_spc.length; i++) {
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<input type="hidden" name="event_id" value="1714573302495_241193308887162_wWbPJSf"><input type="hidden" name="timeToSubmit" value="4">
</form>Text Content
*
* MOTHER'S DAY BOX
$20 gift card, Cake Pop, 16oz Drink, Small assorted flowers
* Name*
* E-mail*
* Contact Number*
-Area CodePhone Number
* Pickup Location*
Please Select Kelso - 209 W. Main St Longivew - 3202 Ocean Beach Hwy Woodland
- 1494 Dike Access Road
* 16oz Drink*
* Cake Pop Flavor*
White Chocolate CaramelRocky Mountain
* Additional Info
* Mother's Day Box
prevnext( X )
*
Mother's Day Box$35.00
Includes $20 Red Leaf Organic Coffee gift card, Cake Pop, 16oz drink and
small assortment of flowers in a Red Leaf Coffee cup.
Additional Gift Card$10.00
Denomination $10 $20 $30 $40 $50
Total $35.00
--------------------------------------------------------------------------------
CREDIT CARD
* Place Order
* Should be Empty: