donate.prolifeprosper.com Open in urlscan Pro
13.57.136.224  Public Scan

Form analysis
4 forms found in the DOM

<form id="donor-form" novalidate="novalidate">
  <div class="form-group row">
    <label for="inputEmail3" class="col-sm-3 col-md-3 col-lg-2 col-form-label">Donor Name</label>
    <div class="col-sm-9 col-md-9 col-lg-10">
      <input type="text" class="form-control" id="inputName" name="inputName" placeholder="Name">
    </div>
  </div>
  <div class="form-group row">
    <label for="inputPassword3" class="col-sm-3 col-md-3 col-lg-2 col-lg-2 col-form-label">Address</label>
    <div class="col-sm-9 col-md-9 col-lg-10">
      <input type="text" class="form-control" id="inputAddress" name="inputAddress" placeholder="Address">
    </div>
  </div>
  <div class="form-group row">
    <label for="inputEmail3" class="col-sm-3 col-md-3 col-lg-2 col-form-label">City</label>
    <div class="col-sm-9 col-md-9 col-lg-10">
      <input type="text" class="form-control" id="inputCity" name="inputCity" placeholder="City">
    </div>
  </div>
  <div class="form-group row">
    <label for="inputPassword3" class="col-sm-3 col-md-3 col-lg-2 col-form-label">State</label>
    <div class="col-sm-9 col-md-9 col-lg-10">
      <select class="form-control" id="inputState" name="inputState">
        <option value=""> State </option>
        <option value="AL">Alabama</option>
        <option value="AK">Alaska</option>
        <option value="AZ">Arizona</option>
        <option value="AR">Arkansas</option>
        <option value="CA">California</option>
        <option value="CO">Colorado</option>
        <option value="CT">Connecticut</option>
        <option value="DE">Delaware</option>
        <option value="DC">District of Columbia</option>
        <option value="FL">Florida</option>
        <option value="GA">Georgia</option>
        <option value="HI">Hawaii</option>
        <option value="ID">Idaho</option>
        <option value="IL">Illinois</option>
        <option value="IN">Indiana</option>
        <option value="IA">Iowa</option>
        <option value="KS">Kansas</option>
        <option value="KY">Kentucky</option>
        <option value="LA">Louisiana</option>
        <option value="ME">Maine</option>
        <option value="MD">Maryland</option>
        <option value="MA">Massachusetts</option>
        <option value="MI">Michigan</option>
        <option value="MN">Minnesota</option>
        <option value="MS">Mississippi</option>
        <option value="MO">Missouri</option>
        <option value="MT">Montana</option>
        <option value="NE">Nebraska</option>
        <option value="NV">Nevada</option>
        <option value="NH">New Hampshire</option>
        <option value="NJ">New Jersey</option>
        <option value="NM">New Mexico</option>
        <option value="NY">New York</option>
        <option value="NC">North Carolina</option>
        <option value="ND">North Dakota</option>
        <option value="OH">Ohio</option>
        <option value="OK">Oklahoma</option>
        <option value="OR">Oregon</option>
        <option value="PA">Pennsylvania</option>
        <option value="RI">Rhode Island</option>
        <option value="SC">South Carolina</option>
        <option value="SD">South Dakota</option>
        <option value="TN">Tennessee</option>
        <option value="TX">Texas</option>
        <option value="UT">Utah</option>
        <option value="VT">Vermont</option>
        <option value="VA">Virginia</option>
        <option value="WA">Washington</option>
        <option value="WV">West Virginia</option>
        <option value="WI">Wisconsin</option>
        <option value="WY">Wyoming</option>
      </select>
    </div>
  </div>
  <div class="form-group row">
    <label for="inputEmail3" class="col-sm-3 col-md-3 col-lg-2 col-form-label">ZIP Code</label>
    <div class="col-sm-9 col-md-9 col-lg-10">
      <input type="text" class="form-control" id="inputZip" name="inputZip" placeholder="ZIP Code">
    </div>
  </div>
  <div class="form-group row">
    <label for="inputPassword3" class="col-sm-3 col-md-3 col-lg-2 col-form-label">Email</label>
    <div class="col-sm-9 col-md-9 col-lg-10">
      <input type="email" class="form-control" id="inputEmail" name="inputEmail" placeholder="Email">
    </div>
  </div>
  <div class="form-group row">
    <label for="inputPassword3" class="col-sm-3 col-md-3 col-lg-2 col-form-label">Phone Number</label>
    <div class="col-sm-9 col-md-9 col-lg-10">
      <input type="tel" class="form-control" id="inputPhone" name="inputPhone" placeholder="Phone Number">
      <input type="hidden" id="DeviceFingerprintRequestId" value="PixZbY3MRh">
    </div>
  </div>
  <div class="form-group row">
    <label for="inputAdditionalNotes" class="col-sm-3 col-md-3 col-lg-2 col-form-label">Additional Notes</label>
    <div class="col-sm-9 col-md-9 col-lg-10">
      <textarea cols="5" class="form-control" id="inputAdditionalNotes" name="inputAdditionalNotes" placeholder="Additional Notes"></textarea>
    </div>
  </div>
</form>

<form id="payment-form" novalidate="novalidate">
  <div class="form-group row">
    <label for="inputEmail3" class="col-sm-3 col-md-4 col-lg-4 col-form-label">Card Number</label>
    <div class="col-sm-9 col-md-8 col-lg-8">
      <input pattern="[0-9]*" type="text" class="form-control" id="inputCreditCard" name="inputCreditCard" placeholder="Card Number">
    </div>
  </div>
  <div class="form-group row">
    <label for="inputPassword3" class="col-sm-3 col-md-4 col-lg-4 col-form-label">Exp. Date</label>
    <div class="col-sm-9 col-md-8 col-lg-8">
      <input type="text" class="form-control" id="inputDate" name="inputDate" placeholder="MM/YY" maxlength="5">
    </div>
  </div>
  <div class="form-group row">
    <label for="inputEmail3" class="col-sm-3 col-md-4 col-lg-4 col-form-label">Security Code</label>
    <div class="col-sm-9 col-md-8 col-lg-8">
      <input type="text" class="form-control" id="inputSecurityCode" name="inputSecurityCode" placeholder="Security Code">
    </div>
  </div>
</form>

<form id="gift-form" novalidate="novalidate">
  <div class="form-group row" id="recurring-row">
    <div class="col-sm-9 col-md-9 col-lg-10"> How often?<br>
      <div class="btn-group btn-group-toggle recurring" data-toggle="buttons">
        <label id="interval-onetime" class="btn btn-success active">
          <input type="radio" name="recurring" value="false" checked=""> One-time </label>
        <label id="interval-recurring" class="btn btn-success  ">
          <input type="radio" name="recurring" value="true"> Monthly </label>
      </div>
    </div>
  </div>
  <div class="form-group row">
    <div class="col-sm-12 col-md-9 col-lg-10"> Donation amount<br>
      <div class="btn-group btn-group-toggle amount flex-wrap" data-toggle="buttons">
        <!--<select class="form-control" id="inputGift">-->
        <!--<option value="25.0000">$25.00</option>-->
        <label class="btn btn-success my-1 active" id="inputGift1">
          <input type="radio" name="inputGift" value="25.0000" checked=""> $25.00 </label>
        <!--<option value="50.0000">$50.00</option>-->
        <label class="btn btn-success my-1 " id="inputGift2">
          <input type="radio" name="inputGift" value="50.0000"> $50.00 </label>
        <!--<option value="100.0000">$100.00</option>-->
        <label class="btn btn-success my-1 " id="inputGift3">
          <input type="radio" name="inputGift" value="100.0000"> $100.00 </label>
        <label class="btn btn-success my-1 otherAmountOption">
          <input type="radio" name="inputGift" value="-1"> Other </label>
      </div>
      <!--
                                            }
                                            <option value="-1">Other</option>
                                        </select>
                                            -->
    </div>
  </div>
  <div class="form-group row">
    <div class="col-sm-12 col-md-9 col-lg-10">
      <input type="text" class="form-control" id="inputOtherAmount" name="inputOtherAmount" placeholder="Other Amount" style="display:none;">
    </div>
  </div>
  <div class="switch-form-group form-group row">
    <div class="col-sm-12 col-md-9 col-lg-10">
      <label class="switch">
        <input type="checkbox" id="inputFeeCb" checked="">
        <span class="slider round"></span>
      </label>
      <i>
                                            <label for="inputPassword3" class="switch-label col-form-label">
                                                By covering the tax-deductible transaction fee, 100% of your donation will go to the cause.
                                            </label>
                                        </i>
    </div>
  </div>
</form>

<form id="totalAmount-form" novalidate="novalidate">
  <div class="form-group row">
    <div class="col-sm-12 col-md-9 col-lg-10">
      <input readonly="" type="text" class="form-control" id="inputTotalGift" name="inputTotalGift" placeholder="">
      <div class="donate-button-row justify-content-center row">
        <div class="col-md-6 text-center" style="margin-top:20px;">
          <button type="button" id="btnDonate" class="btn btn-success ladda-button" data-style="zoom-out">Donate</button>
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

Life & Family Educational Trust
 * Support Home
 * About us
 * Volunteer

Donate now

DONOR INFORMATION

--------------------------------------------------------------------------------

Donor Name

Address

City

State
State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware
District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas
Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi
Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York
North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South
Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West
Virginia Wisconsin Wyoming
ZIP Code

Email

Phone Number

Additional Notes


PAYMENT INFORMATION

--------------------------------------------------------------------------------

Card Number

Exp. Date

Security Code


YOUR DONATION

--------------------------------------------------------------------------------

How often?

One-time Monthly
Donation amount

$25.00 $50.00 $100.00 Other

By covering the tax-deductible transaction fee, 100% of your donation will go to
the cause.

TOTAL DONATION

Donate

LIFE AFFIRMING SUPPORT

We empower women and families facing unexpected pregnancies in Bettendorf, IA.
We provide evidence-based information, free services, and practical support with
a holistic and compassionate approach. ?We give each of our patients the care
and attention they need, empowering them to make an informed decision for
themselves and their future. Women's Choice Center is a 501c3 non-profit in the
state of Iowa and a ministry of Life and Family Educational Trust.. Community
support ensures our ability to meet the needs of local women and men facing
unexpected pregnancies. We are 100% funded through the generosity of
individuals, businesses, and organizations in our community. All donations are
tax-deductible. Contact us to learn more about how to get involved, upcoming
events, or become a monthly supporter. 563-332-0475

Goal: $0.00

Donated: $32,188.00

Remaining: $0.00



YOU ARE PROVIDING LIFE AFFIRMING RESOURCES FOR MOMS, DADS AND BABIES IN THEIR
TIME OF CRITICAL NEED. - LIFE & FAMILY EDUCATIONAL TRUST TAX ID: 37-6358005


 * Support Home
 * About us
 * Volunteer