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Submitted URL: http://www.cognitoforms.com/ArmyAviationAssociationOfAmerica/AAAAIndustryMembershipDues
Effective URL: https://www.cognitoforms.com/ArmyAviationAssociationOfAmerica/AAAAIndustryMembershipDues
Submission: On October 07 via manual from US — Scanned from DE
Effective URL: https://www.cognitoforms.com/ArmyAviationAssociationOfAmerica/AAAAIndustryMembershipDues
Submission: On October 07 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
<form lang="en" tabindex="-1" class="😉 cog-cognito cog-form cog-114 is-default cog-cognito--styled cog-form--light-background" data-width="800 700 650 625 600 575 550 525 500 475 450 425 400 375 350 325 300 275 250 225 200">
<div class="cog-form__container">
<div class="cog-form__content">
<header class="cog-header cog-wrapper cog-header--row cog-header--left"><img src="https://www.cognitoforms.com/file/96pZtSOjOu6TqZdlHygYvi-f844rfE3RlSddHyCKZq5YyZHhRUXykdrQ-LpG-egp">
<div class="cog-header__text">
<h1 class="cog-heading">AAAA Industry Membership Dues</h1>
<div class="cog-header__description">Payments are processed in Square.</div>
</div>
</header>
<div class="cog-body"><!---->
<div class="v-portal" style="display: none;"></div>
<div class="cog-page cog-wrapper cog-transition-ltr"><!---->
<div class="cog-row">
<div class="cog-col cog-col--24">
<div class="cog-content cog-html cog-input">
<p><strong>This page is for Industry dues only.</strong></p>
<p>If you are renewing your personal membership, please go
to <a title="Membership Renew" href="https://www.quad-a.org/Public/AAAA_Membership/Renew_AAAA_Membership/Public/AAAA_Membership/member_renew.aspx?hkey=7a2bd419-986f-457d-b1ad-c77337be02e8" target="_top">quad-a.org</a> and use
the Membership Renew option.</p>
</div>
</div>
</div>
<div class="cog-row">
<div class="cog-field cog-field--2 cog-col cog-col--24 cog-text cog-text--singleline is-required"><label id="cog-0-label" for="cog-0" class="cog-label"> Company Name<span aria-hidden="true" class="cog-asterisk">*</span> <span
class="cog-offscreen">(required)</span> <!----></label>
<div class="cog-input">
<div class="el-input"><!----><input type="text" autocomplete="off" id="cog-0" placeholder="" class="el-input__inner"><!----><!----><!----><!----></div>
</div>
<div class="cog-field__placeholder cog-input">
<div class="cog-field__placeholder-inner"> </div>
</div> <!----> <!----> <!---->
</div>
</div>
<div class="cog-row">
<div class="cog-col cog-col--24">
<div class="cog-content cog-html cog-input">
<p>Please type Name of Company as it appears on the Invoice. Please email <a href="mailto:IndustryM@quad-a.org">IndustryM@quad-a.org</a> if your company name has changed.</p>
</div>
</div>
</div>
<div class="cog-row">
<div class="cog-field cog-field--39 cog-col cog-col--12 cog-text cog-text--singleline is-required"><label id="cog-1-label" for="cog-1" class="cog-label"> Invoice # or Member # from Invoice:<span aria-hidden="true"
class="cog-asterisk">*</span> <span class="cog-offscreen">(required)</span> <!----></label>
<div class="cog-input">
<div class="el-input"><!----><input type="text" autocomplete="off" id="cog-1" placeholder="" class="el-input__inner"><!----><!----><!----><!----></div>
</div>
<div class="cog-field__placeholder cog-input">
<div class="cog-field__placeholder-inner"> </div>
</div> <!----> <!----> <!---->
</div>
</div>
<div class="cog-row">
<fieldset class="cog-field cog-field--4 cog-col cog-col--24 cog-name is-required">
<legend class="cog-label"> Individual Submitting Payment<span aria-hidden="true" class="cog-asterisk">*</span> <span class="cog-offscreen">(required)</span> <!----></legend>
<div class="cog-name">
<div class="cog-row">
<div class="cog-name__group">
<div class="cog-input cog-name__prefix cog-input--small">
<div class="el-input"><!----><input type="text" autocomplete="honorific-prefix" aria-label="Title" id="cog-input-auto-0" placeholder="Title" title="Title" class="el-input__inner"><!----><!----><!----><!----></div>
</div>
<div class="cog-input cog-name__first cog-input--long">
<div class="el-input"><!----><input type="text" autocomplete="given-name" aria-label="First" id="cog-input-auto-1" placeholder="First" title="First" class="el-input__inner"><!----><!----><!----><!----></div>
</div>
<div class="cog-input cog-name__middle-initial cog-input--tiny">
<div class="el-input"><!----><input type="text" autocomplete="additional-name" aria-label="MI" id="cog-input-auto-2" placeholder="MI" title="MI" class="el-input__inner"><!----><!----><!----><!----></div>
</div> <!---->
</div>
<div class="cog-name__group">
<div class="cog-input cog-name__last cog-input--long">
<div class="el-input"><!----><input type="text" autocomplete="family-name" aria-label="Last" id="cog-input-auto-3" placeholder="Last" title="Last" class="el-input__inner"><!----><!----><!----><!----></div>
</div>
<div class="cog-input cog-name__suffix cog-input--small">
<div class="el-input"><!----><input type="text" autocomplete="honorific-suffix" aria-label="Suffix" id="cog-input-auto-4" placeholder="Suffix" title="Suffix" class="el-input__inner"><!----><!----><!----><!----></div>
</div>
</div>
</div>
</div>
<div class="cog-field__placeholder cog-input">
<div class="cog-field__placeholder-inner"> </div>
</div> <!----> <!----> <!---->
</fieldset>
</div>
<div class="cog-row">
<div class="cog-field cog-field--5 cog-col cog-col--12 cog-phone cog-phone--us is-required"><label id="cog-3-label" for="cog-3" class="cog-label"> Contact Phone<span aria-hidden="true" class="cog-asterisk">*</span> <span
class="cog-offscreen">(required)</span> <!----></label>
<div class="cog-input">
<div class="el-input"><!----><input type="text" autocomplete="tel-national" id="cog-3" placeholder="" class="el-input__inner"><!----><!----><!----><!----></div>
</div>
<div class="cog-field__placeholder cog-input">
<div class="cog-field__placeholder-inner"> </div>
</div> <!----> <!----> <!---->
</div>
<div class="cog-field cog-field--6 cog-col cog-col--12 cog-email is-required"><label id="cog-4-label" for="cog-4" class="cog-label"> Contact Email<span aria-hidden="true" class="cog-asterisk">*</span> <span
class="cog-offscreen">(required)</span> <!----></label>
<div class="cog-input">
<div class="el-input"><!----><input type="text" autocomplete="email" id="cog-4" placeholder="" class="el-input__inner"><!----><!----><!----><!----></div>
</div>
<div class="cog-field__placeholder cog-input">
<div class="cog-field__placeholder-inner"> </div>
</div> <!----> <!----> <!---->
</div>
</div>
<div class="cog-row">
<div class="cog-field cog-field--38 cog-col cog-col--12 cog-currency is-required"><label id="cog-5-label" for="cog-5" class="cog-label"> Amount Due from Invoice:<span aria-hidden="true" class="cog-asterisk">*</span> <span
class="cog-offscreen">(required)</span> <!----></label>
<div class="cog-input">
<div class="el-input"><!----><input type="text" autocomplete="off" id="cog-5" placeholder="" inputmode="" class="el-input__inner"><!----><!----><!----><!----></div>
</div>
<div class="cog-field__placeholder cog-input">
<div class="cog-field__placeholder-inner"> </div>
</div> <!----> <!----> <!---->
</div>
</div>
<div class="vue-portal-target">
<section class="cog-payment cog-section cog-payment--square" style="display: none;">
<div class="cog-section__inner">
<h2 class="cog-heading"> Card Authorization </h2>
<div class="cog-row">
<div class="cog-col cog-col--24">
<section class="cog-section__inner cog-section__inner--background"><!---->
<div class="cog-row cog-payment__content-row">
<div class="cog-col cog-col--12" style="display: none;">
<div class="cog-payment__field">
<div class="cog-input" style="display: none;">
<div class="el-input"><!----><input type="text" autocomplete="off" id="cog-input-auto-5" placeholder="placeholder" inputmode="numeric" class="el-input__inner" enterkeyhint="Go"><!----><!----><!----><!----></div>
</div>
<div class="cog-square-payment" currency-code="USD">
<div>
<div id="card-container" class="cog-square-card cog-payment__frame">
<div id="single-card-wrapper-14b7dc0b-a12d-6991-e172-030a788e095d" class="sq-card-wrapper">
<div class="sq-card-iframe-container" style="height: 97px;"><iframe frameborder="0" height="97px" name="single-card-14b7dc0b-a12d-6991-e172-030a788e095d" scrolling="no"
src="https://web.squarecdn.com/1.60.9/single-card-element-iframe.html" width="100%" class="sq-card-component"></iframe></div><span class="sq-card-message"></span>
</div>
</div>
<script src="https://web.squarecdn.com/v1/square.js"></script>
</div>
</div> <!----> <!---->
<style class="payment-input-styles">
:root:root:root:root:root .cog-payment__field .cog-payment__frame .cog-input>div {
background-color: rgb(255, 255, 255);
background-image: none;
background-position: 0% 0%;
background-repeat: repeat;
background-size: auto;
border-top-color: rgb(204, 204, 204);
border-top-left-radius: 0px;
border-top-right-radius: 0px;
border-top-style: solid;
border-top-width: 1px;
border-right-color: rgb(204, 204, 204);
border-right-style: solid;
border-right-width: 1px;
border-bottom-color: rgb(204, 204, 204);
border-bottom-left-radius: 0px;
border-bottom-right-radius: 0px;
border-bottom-style: solid;
border-bottom-width: 1px;
border-left-color: rgb(204, 204, 204);
border-left-style: solid;
border-left-width: 1px;
box-shadow: none;
padding-top: 8px;
padding-right: 10px;
padding-bottom: 8px;
padding-left: 10px;
}
</style>
</div>
</div> <!---->
</div>
</section>
</div>
</div>
</div>
</section>
</div>
<div class="cog-row" style="display: none;">
<div class="cog-field cog-col cog-col--12"><!----></div>
</div>
<div class="cog-page__navigation"><!----> <button type="submit" class="el-button cog-button--has-status cog-button--primary cog-button--navigation cog-button--submit el-button--default cog-button" data-next=""
data-action-name="Submit"><!----><!----><span><!----> <span class="cog-button__text"> Submit </span> <!----> </span></button> <button type="button"
class="el-button cog-button--has-status cog-button--save cog-button--secondary cog-button--navigation el-button--default cog-button"><!----><!----><span><!----> <span class="cog-button__text"> Save</span> <!----> </span></button></div>
<!---->
</div>
</div>
<div tabindex="0" class="cog-dialog cog-save-resume-dialog" emailmessage="">
<div class="el-dialog__wrapper" style="display: none;">
<div role="dialog" aria-modal="true" aria-label="dialog" class="el-dialog" style="margin-top: 15vh;">
<div class="el-dialog__header"><span class="el-dialog__title"></span><button type="button" aria-label="Close" class="el-dialog__headerbtn" title="Close"><i class="el-dialog__close el-icon el-icon-close"></i><svg viewBox="0 0 18 18"
focusable="false" class="cog-icon cog-i-ex">
<defs></defs>
<g>
<path d="M4.2 4.2l9.6 9.6M13.8 4.2l-9.6 9.6"></path>
</g>
</svg></button></div><!----><!---->
</div>
</div>
</div><!----><!---->
</div>
</div>
</form>Text Content
AAAA INDUSTRY MEMBERSHIP DUES Payments are processed in Square. This page is for Industry dues only. If you are renewing your personal membership, please go to quad-a.org and use the Membership Renew option. Company Name* (required)  Please type Name of Company as it appears on the Invoice. Please email IndustryM@quad-a.org if your company name has changed. Invoice # or Member # from Invoice:* (required)  Individual Submitting Payment* (required)  Contact Phone* (required)  Contact Email* (required)  Amount Due from Invoice:* (required)  CARD AUTHORIZATION Submit Save