28jun.org Open in urlscan Pro
198.71.189.253  Public Scan

Submitted URL: https://clicks.fanbridge.com/l.php?cid=1588111&sid=303039118&url=https%3A%2F%2F28jun.org%2Fdonate%2F
Effective URL: https://28jun.org/donate/
Submission: On March 10 via api from CH — Scanned from DE

Form analysis 1 forms found in the DOM

POST https://28jun.org/donate/?payment-mode=paypalpro_payflow&form-id=605

<form id="give-form-605-1" class="give-form give-form-605 give-form-type-multi give-recurring-form" action="https://28jun.org/donate/?payment-mode=paypalpro_payflow&amp;form-id=605" data-id="605-1" data-currency_symbol="$" data-currency_code="USD"
  data-currency_position="before" data-thousands_separator="," data-decimal_separator="." data-number_decimals="0" method="post"> <span class="give-hidden" style="display: none !important;"> <label for="give-form-honeypot-605"></label> <input
      id="give-form-honeypot-605" type="text" name="give-honeypot" class="give-honeypot give-hidden"> </span> <input type="hidden" name="give-form-id-prefix" value="605-1"> <input type="hidden" name="give-form-id" value="605"> <input type="hidden"
    name="give-form-title" value="Donate today and save lives."> <input type="hidden" name="give-current-url" value="https://28jun.org/donate/"> <input type="hidden" name="give-form-url" value="https://28jun.org/donate/"> <input type="hidden"
    name="give-form-minimum" value="7"> <input type="hidden" name="give-form-maximum" value="1000000"> <input type="hidden" name="give-form-hash" value="56578a1753" data-time="1646950582" data-nonce-life="86400" data-donor-session="0"><input
    type="hidden" name="give-price-id" value="7"> <input type="hidden" name="give-recurring-logged-in-only" class="give-recurring-logged-in-only" value=""> <input type="hidden" name="give-logged-in-only" class="give-logged-in-only" value="1"> <input
    type="hidden" name="_give_is_donation_recurring" class="_give_is_donation_recurring skrollable skrollable-between" id="_give_is_donation_recurring" value="0" data-_give_recurring="yes_donor" data-_give_checkbox_default="no"
    data-_give_price_option=""><input type="hidden" name="give_recurring_donation_details" class="give_recurring_donation_details" id="give_recurring_donation_details" value="{&quot;give_recurring_option&quot;:&quot;yes_donor&quot;}">
  <div class="give-total-wrap">
    <div class="give-donation-amount form-row-wide"> <span class="give-currency-symbol give-currency-position-before">$</span> <label class="give-hidden" for="give-amount">Donation Amount:</label> <input class="give-text-input give-amount-top"
        id="give-amount" name="give-amount" type="text" inputmode="decimal" placeholder="" value="35" autocomplete="off"></div>
  </div> <label for="give-donation-level-select-605" class="give-hidden">Choose Your Donation Amount:</label><select id="give-donation-level-select-605" class="give-select give-select-level give-donation-levels-wrap">
    <option data-price-id="2" class="give-donation-level-2" value="10" data-default="0">$10</option>
    <option data-price-id="3" class="give-donation-level-3" value="30" data-default="0">$30</option>
    <option data-price-id="7" class="give-donation-level-7 give-default-level" value="35" selected="selected" data-default="1">$35</option>
    <option data-price-id="4" class="give-donation-level-4" value="50" data-default="0">$50</option>
    <option data-price-id="5" class="give-donation-level-5" value="100" data-default="0">$100</option>
    <option data-price-id="6" class="give-donation-level-6" value="150" data-default="0">$150</option>
    <option data-price-id="1" class="give-donation-level-1" value="300" data-default="0">$300</option>
    <option data-price-id="custom" class="give-donation-level-custom" value="custom">Custom</option>
  </select>
  <div class="give-recurring-donors-choice"> <input id="give-admin_choice-605" class="give-recurring-period" name="give-recurring-period" type="checkbox" data-period-label="Monthly" data-period="month" data-interval="1"> <label
      for="give-admin_choice-605">Make this donation monthly</label></div> <button type="button" class="give-btn give-btn-modal">Donate Now</button>
  <fieldset id="give-tributes-dedicate-donation-605" class="give-tributes-dedicate-donation"> <input type="hidden" class="give-tributes-type" name="give_tributes_type" value="In honor of">
    <legend>Dedicate this Donation</legend>
    <div id="give-tributes-options-605">
      <ul id="give-tributes-show-wrap-605" class="give-tributes-show-wrap">
        <li class="give-tributes-show-wrap-li"> <input class="give-input" type="radio" id="give-tributes-yes-605" name="give_tributes_show_dedication" value="yes"> <label for="give-tributes-yes-605" class="give-tributes-yes"> Yes, please</label></li>
        <li class="give-tributes-show-wrap-li"> <input class="give-input" type="radio" id="give-tributes-no-605" name="give_tributes_show_dedication" checked="checked" value="no"> <label for="give-tributes-no-605" class="give-tributes-no"> No, thank
            you</label></li>
      </ul>
    </div>
    <div id="give-tributes-type-wrap-605" class="has_radios give_tributes_type_wrap" style="display: none;"> <label class="give-tributes-label" for="give-tribute-type-605" id="give-tribute-type-605">Dedication Type</label>
      <ul id="give-tributes-type-radio-list-605" class="give-tribute-radio-ul">
        <li><input type="radio" id="give-tributes-type-radio-in-honor-of-605" name="give_tributes_radio_type" data-tribute-type="In honor of" class="give-tribute-type-radio" value="In honor of" checked="checked"><label
            for="give-tributes-type-radio-in-honor-of-605" class="give-tributes-type-radio">In honor of</label></li>
        <li><input type="radio" id="give-tributes-type-radio-in-memory-of-605" name="give_tributes_radio_type" data-tribute-type="In memory of" class="give-tribute-type-radio" value="In memory of"><label
            for="give-tributes-type-radio-in-memory-of-605" class="give-tributes-type-radio">In memory of</label></li>
      </ul>
    </div>
    <div id="give-tributes-info-wrap-605" class="give_tributes_info_wrap" style="display: none;">
      <h3 class="give-section-break give-tributes-legend">Honoree Details</h3>
      <p id="give-tributes-first-name-wrap-605" class="form-row form-row-first form-row-responsive"> <label class="give-label" for="give-tributes-first-name-605"> First Name <span class="give-required-indicator">*</span> <span
            class="give-tooltip hint--top" data-tooltip="The first name of the honoree." aria-label="The first name of the honoree."><i class="give-icon give-icon-question"></i></span> </label> <input class="give-input required" type="text"
          name="give_tributes_first_name" placeholder="Honoree First Name" id="give-tributes-first-name-605" value=""></p>
      <p id="give-tributes-last-name-wrap-605" class="form-row form-row-last form-row-responsive"> <label class="give-label" for="give-tributes-last-name-605"> Last Name <span class="give-tooltip hint--top"
            data-tooltip="The last name of the honoree." aria-label="The last name of the honoree."><i class="give-icon give-icon-question"></i></span> </label> <input class="give-input " type="text" name="give_tributes_last_name"
          placeholder="Honoree Last Name" id="give-tributes-last-name-605" value=""></p>
    </div>
  </fieldset>
  <fieldset id="give-payment-mode-select">
    <legend class="give-payment-mode-label">Select Payment Method <span class="give-loading-text" style="display: none;"><span class="give-loading-animation"></span> </span></legend>
    <div id="give-payment-mode-wrap">
      <ul id="give-gateway-radio-list">
        <li> <input type="radio" name="payment-mode" class="give-gateway" id="give-gateway-paypal-605-1" value="paypal"> <label for="give-gateway-paypal-605-1" class="give-gateway-option" id="give-gateway-option-paypal"> PayPal</label></li>
        <li class="give-gateway-option-selected"> <input type="radio" name="payment-mode" class="give-gateway" id="give-gateway-paypalpro_payflow-605-1" value="paypalpro_payflow" checked="checked"> <label for="give-gateway-paypalpro_payflow-605-1"
            class="give-gateway-option" id="give-gateway-option-paypalpro_payflow"> Credit Card</label></li>
      </ul>
    </div>
  </fieldset>
  <div id="give_purchase_form_wrap">
    <fieldset id="give_checkout_user_info" class="">
      <legend> Personal Info</legend>
      <p id="give-first-name-wrap" class="form-row form-row-first form-row-responsive"> <label class="give-label" for="give-first"> First Name <span class="give-required-indicator">*</span> <span
            class="give-tooltip hint--top hint--medium hint--bounce" aria-label="First Name is used to personalize your donation record." rel="tooltip"><i class="give-icon give-icon-question"></i></span> </label> <input class="give-input required"
          type="text" name="give_first" autocomplete="given-name" placeholder="First Name" id="give-first" value="" required="" aria-required="true"></p>
      <p id="give-last-name-wrap" class="form-row form-row-last form-row-responsive"> <label class="give-label" for="give-last"> Last Name <span class="give-tooltip hint--top hint--medium hint--bounce"
            aria-label="Last Name is used to personalize your donation record." rel="tooltip"><i class="give-icon give-icon-question"></i></span> </label> <input class="give-input" type="text" name="give_last" autocomplete="family-name"
          id="give-last" placeholder="Last Name" value=""></p>
      <p id="give-email-wrap" class="form-row form-row-wide"> <label class="give-label" for="give-email"> Email Address <span class="give-required-indicator">*</span> <span class="give-tooltip hint--top hint--medium hint--bounce"
            aria-label="We will send the donation receipt to this address." rel="tooltip"><i class="give-icon give-icon-question"></i></span> </label> <input class="give-input required" type="email" name="give_email" autocomplete="email"
          placeholder="Email Address" id="give-email" value="" required="" aria-required="true"></p>
    </fieldset>
    <fieldset id="give_cc_fields-605" class="give-do-validate">
      <legend>Credit Card Info</legend>
      <div id="give_secure_site_wrapper-605"> <span class="give-icon padlock"></span> <span>This is a secure SSL encrypted payment.</span></div>
      <p id="give-card-number-wrap-605" class="form-row form-row-two-thirds form-row-responsive"> <label for="card_number-605" class="give-label"> Card Number <span class="give-required-indicator">*</span> <span
            class="give-tooltip hint--top hint--medium hint--bounce" aria-label="The (typically) 16 digits on the front of your credit card." rel="tooltip"><i class="give-icon give-icon-question"></i></span> <span class="card-type"></span> </label>
        <input type="tel" autocomplete="off" name="card_number" id="card_number-605" class="card-number give-input required" placeholder="Card Number" required="" aria-required="true"></p>
      <p id="give-card-cvc-wrap-605" class="form-row form-row-one-third form-row-responsive"> <label for="card_cvc-605" class="give-label"> CVC <span class="give-required-indicator">*</span> <span
            class="give-tooltip hint--top hint--medium hint--bounce" aria-label="The 3 digit (back) or 4 digit (front) value on your card." rel="tooltip"><i class="give-icon give-icon-question"></i></span> </label> <input type="tel" size="4"
          autocomplete="off" name="card_cvc" id="card_cvc-605" class="card-cvc give-input required" placeholder="CVC" required="" aria-required="true"></p>
      <p id="give-card-name-wrap-605" class="form-row form-row-two-thirds form-row-responsive"> <label for="card_name-605" class="give-label"> Cardholder Name <span class="give-required-indicator">*</span> <span
            class="give-tooltip hint--top hint--medium hint--bounce" aria-label="The name of the credit card account holder." rel="tooltip"><i class="give-icon give-icon-question"></i></span> </label> <input type="text" autocomplete="off"
          name="card_name" id="card_name-605" class="card-name give-input required" placeholder="Cardholder Name" required="" aria-required="true"></p>
      <p class="card-expiration form-row form-row-one-third form-row-responsive"> <label for="card_expiry-605" class="give-label"> Expiration <span class="give-required-indicator">*</span> <span
            class="give-tooltip hint--top hint--medium hint--bounce" aria-label="The date your credit card expires, typically on the front of the card." rel="tooltip"><i class="give-icon give-icon-question"></i></span> </label> <input type="hidden"
          id="card_exp_month-605" name="card_exp_month" class="card-expiry-month"> <input type="hidden" id="card_exp_year-605" name="card_exp_year" class="card-expiry-year"> <input type="tel" autocomplete="off" name="card_expiry" id="card_expiry-605"
          class="card-expiry give-input required" placeholder="MM / YY" required="" aria-required="true"></p>
    </fieldset>
    <fieldset id="give_cc_address" class="cc-address">
      <legend>Billing Details</legend>
      <p id="give-card-country-wrap" class="form-row form-row-wide"> <label for="billing_country" class="give-label"> Country <span class="give-required-indicator">*</span> <span class="give-tooltip hint--top"
            data-tooltip="The country for your billing address." aria-label="The country for your billing address."><i class="give-icon give-icon-question"></i></span> </label> <select name="billing_country" autocomplete="country"
          id="billing_country" class="billing-country billing_country give-select required" required="" aria-required="true">
          <option value=""></option>
          <option value="US">United States</option>
          <option value="CA" selected="selected">Canada</option>
          <option value="GB">United Kingdom</option>
          <option value="AF">Afghanistan</option>
          <option value="AL">Albania</option>
          <option value="DZ">Algeria</option>
          <option value="AS">American Samoa</option>
          <option value="AD">Andorra</option>
          <option value="AO">Angola</option>
          <option value="AI">Anguilla</option>
          <option value="AQ">Antarctica</option>
          <option value="AG">Antigua and Barbuda</option>
          <option value="AR">Argentina</option>
          <option value="AM">Armenia</option>
          <option value="AW">Aruba</option>
          <option value="AU">Australia</option>
          <option value="AT">Austria</option>
          <option value="AZ">Azerbaijan</option>
          <option value="BS">Bahamas</option>
          <option value="BH">Bahrain</option>
          <option value="BD">Bangladesh</option>
          <option value="BB">Barbados</option>
          <option value="BY">Belarus</option>
          <option value="BE">Belgium</option>
          <option value="BZ">Belize</option>
          <option value="BJ">Benin</option>
          <option value="BM">Bermuda</option>
          <option value="BT">Bhutan</option>
          <option value="BO">Bolivia</option>
          <option value="BA">Bosnia and Herzegovina</option>
          <option value="BW">Botswana</option>
          <option value="BV">Bouvet Island</option>
          <option value="BR">Brazil</option>
          <option value="IO">British Indian Ocean Territory</option>
          <option value="BN">Brunei Darrussalam</option>
          <option value="BG">Bulgaria</option>
          <option value="BF">Burkina Faso</option>
          <option value="BI">Burundi</option>
          <option value="KH">Cambodia</option>
          <option value="CM">Cameroon</option>
          <option value="CV">Cape Verde</option>
          <option value="KY">Cayman Islands</option>
          <option value="CF">Central African Republic</option>
          <option value="TD">Chad</option>
          <option value="CL">Chile</option>
          <option value="CN">China</option>
          <option value="CX">Christmas Island</option>
          <option value="CC">Cocos Islands</option>
          <option value="CO">Colombia</option>
          <option value="KM">Comoros</option>
          <option value="CD">Congo, Democratic People's Republic</option>
          <option value="CG">Congo, Republic of</option>
          <option value="CK">Cook Islands</option>
          <option value="CR">Costa Rica</option>
          <option value="CI">Cote d'Ivoire</option>
          <option value="HR">Croatia/Hrvatska</option>
          <option value="CU">Cuba</option>
          <option value="CY">Cyprus Island</option>
          <option value="CZ">Czech Republic</option>
          <option value="DK">Denmark</option>
          <option value="DJ">Djibouti</option>
          <option value="DM">Dominica</option>
          <option value="DO">Dominican Republic</option>
          <option value="TP">East Timor</option>
          <option value="EC">Ecuador</option>
          <option value="EG">Egypt</option>
          <option value="GQ">Equatorial Guinea</option>
          <option value="SV">El Salvador</option>
          <option value="ER">Eritrea</option>
          <option value="EE">Estonia</option>
          <option value="ET">Ethiopia</option>
          <option value="FK">Falkland Islands</option>
          <option value="FO">Faroe Islands</option>
          <option value="FJ">Fiji</option>
          <option value="FI">Finland</option>
          <option value="FR">France</option>
          <option value="GF">French Guiana</option>
          <option value="PF">French Polynesia</option>
          <option value="TF">French Southern Territories</option>
          <option value="GA">Gabon</option>
          <option value="GM">Gambia</option>
          <option value="GE">Georgia</option>
          <option value="DE">Germany</option>
          <option value="GR">Greece</option>
          <option value="GH">Ghana</option>
          <option value="GI">Gibraltar</option>
          <option value="GL">Greenland</option>
          <option value="GD">Grenada</option>
          <option value="GP">Guadeloupe</option>
          <option value="GU">Guam</option>
          <option value="GT">Guatemala</option>
          <option value="GG">Guernsey</option>
          <option value="GN">Guinea</option>
          <option value="GW">Guinea-Bissau</option>
          <option value="GY">Guyana</option>
          <option value="HT">Haiti</option>
          <option value="HM">Heard and McDonald Islands</option>
          <option value="VA">Holy See (City Vatican State)</option>
          <option value="HN">Honduras</option>
          <option value="HK">Hong Kong</option>
          <option value="HU">Hungary</option>
          <option value="IS">Iceland</option>
          <option value="IN">India</option>
          <option value="ID">Indonesia</option>
          <option value="IR">Iran</option>
          <option value="IQ">Iraq</option>
          <option value="IE">Ireland</option>
          <option value="IM">Isle of Man</option>
          <option value="IL">Israel</option>
          <option value="IT">Italy</option>
          <option value="JM">Jamaica</option>
          <option value="JP">Japan</option>
          <option value="JE">Jersey</option>
          <option value="JO">Jordan</option>
          <option value="KZ">Kazakhstan</option>
          <option value="KE">Kenya</option>
          <option value="KI">Kiribati</option>
          <option value="KW">Kuwait</option>
          <option value="KG">Kyrgyzstan</option>
          <option value="LA">Lao People's Democratic Republic</option>
          <option value="LV">Latvia</option>
          <option value="LB">Lebanon</option>
          <option value="LS">Lesotho</option>
          <option value="LR">Liberia</option>
          <option value="LY">Libyan Arab Jamahiriya</option>
          <option value="LI">Liechtenstein</option>
          <option value="LT">Lithuania</option>
          <option value="LU">Luxembourg</option>
          <option value="MO">Macau</option>
          <option value="MK">Macedonia</option>
          <option value="MG">Madagascar</option>
          <option value="MW">Malawi</option>
          <option value="MY">Malaysia</option>
          <option value="MV">Maldives</option>
          <option value="ML">Mali</option>
          <option value="MT">Malta</option>
          <option value="MH">Marshall Islands</option>
          <option value="MQ">Martinique</option>
          <option value="MR">Mauritania</option>
          <option value="MU">Mauritius</option>
          <option value="YT">Mayotte</option>
          <option value="MX">Mexico</option>
          <option value="FM">Micronesia</option>
          <option value="MD">Moldova, Republic of</option>
          <option value="MC">Monaco</option>
          <option value="MN">Mongolia</option>
          <option value="ME">Montenegro</option>
          <option value="MS">Montserrat</option>
          <option value="MA">Morocco</option>
          <option value="MZ">Mozambique</option>
          <option value="MM">Myanmar</option>
          <option value="NA">Namibia</option>
          <option value="NR">Nauru</option>
          <option value="NP">Nepal</option>
          <option value="NL">Netherlands</option>
          <option value="AN">Netherlands Antilles</option>
          <option value="NC">New Caledonia</option>
          <option value="NZ">New Zealand</option>
          <option value="NI">Nicaragua</option>
          <option value="NE">Niger</option>
          <option value="NG">Nigeria</option>
          <option value="NU">Niue</option>
          <option value="NF">Norfolk Island</option>
          <option value="KP">North Korea</option>
          <option value="MP">Northern Mariana Islands</option>
          <option value="NO">Norway</option>
          <option value="OM">Oman</option>
          <option value="PK">Pakistan</option>
          <option value="PW">Palau</option>
          <option value="PS">Palestinian Territories</option>
          <option value="PA">Panama</option>
          <option value="PG">Papua New Guinea</option>
          <option value="PY">Paraguay</option>
          <option value="PE">Peru</option>
          <option value="PH">Philippines</option>
          <option value="PN">Pitcairn Island</option>
          <option value="PL">Poland</option>
          <option value="PT">Portugal</option>
          <option value="PR">Puerto Rico</option>
          <option value="QA">Qatar</option>
          <option value="RE">Reunion Island</option>
          <option value="RO">Romania</option>
          <option value="RU">Russian Federation</option>
          <option value="RW">Rwanda</option>
          <option value="SH">Saint Helena</option>
          <option value="KN">Saint Kitts and Nevis</option>
          <option value="LC">Saint Lucia</option>
          <option value="PM">Saint Pierre and Miquelon</option>
          <option value="VC">Saint Vincent and the Grenadines</option>
          <option value="SM">San Marino</option>
          <option value="ST">Sao Tome and Principe</option>
          <option value="SA">Saudi Arabia</option>
          <option value="SN">Senegal</option>
          <option value="RS">Serbia</option>
          <option value="SC">Seychelles</option>
          <option value="SL">Sierra Leone</option>
          <option value="SG">Singapore</option>
          <option value="SK">Slovak Republic</option>
          <option value="SI">Slovenia</option>
          <option value="SB">Solomon Islands</option>
          <option value="SO">Somalia</option>
          <option value="ZA">South Africa</option>
          <option value="GS">South Georgia</option>
          <option value="KR">South Korea</option>
          <option value="ES">Spain</option>
          <option value="LK">Sri Lanka</option>
          <option value="SD">Sudan</option>
          <option value="SR">Suriname</option>
          <option value="SJ">Svalbard and Jan Mayen Islands</option>
          <option value="SZ">Eswatini</option>
          <option value="SE">Sweden</option>
          <option value="CH">Switzerland</option>
          <option value="SY">Syrian Arab Republic</option>
          <option value="TW">Taiwan</option>
          <option value="TJ">Tajikistan</option>
          <option value="TZ">Tanzania</option>
          <option value="TG">Togo</option>
          <option value="TK">Tokelau</option>
          <option value="TO">Tonga</option>
          <option value="TH">Thailand</option>
          <option value="TT">Trinidad and Tobago</option>
          <option value="TN">Tunisia</option>
          <option value="TR">Turkey</option>
          <option value="TM">Turkmenistan</option>
          <option value="TC">Turks and Caicos Islands</option>
          <option value="TV">Tuvalu</option>
          <option value="UG">Uganda</option>
          <option value="UA">Ukraine</option>
          <option value="AE">United Arab Emirates</option>
          <option value="UY">Uruguay</option>
          <option value="UM">US Minor Outlying Islands</option>
          <option value="UZ">Uzbekistan</option>
          <option value="VU">Vanuatu</option>
          <option value="VE">Venezuela</option>
          <option value="VN">Vietnam</option>
          <option value="VG">Virgin Islands (British)</option>
          <option value="VI">Virgin Islands (USA)</option>
          <option value="WF">Wallis and Futuna Islands</option>
          <option value="EH">Western Sahara</option>
          <option value="WS">Western Samoa</option>
          <option value="YE">Yemen</option>
          <option value="YU">Yugoslavia</option>
          <option value="ZM">Zambia</option>
          <option value="ZW">Zimbabwe</option>
        </select></p>
      <p id="give-card-address-wrap" class="form-row form-row-wide"> <label for="card_address" class="give-label"> Address 1 <span class="give-required-indicator">*</span> <span class="give-tooltip hint--top hint--medium hint--bounce"
            aria-label="The primary billing address for your credit card." rel="tooltip"><i class="give-icon give-icon-question"></i></span> </label> <input type="text" id="card_address" name="card_address" autocomplete="address-line1"
          class="card-address give-input required" placeholder="Address line 1" value="" required="" aria-required="true"></p>
      <p id="give-card-address-2-wrap" class="form-row form-row-wide"> <label for="card_address_2" class="give-label"> Address 2 <span class="give-tooltip hint--top hint--medium hint--bounce"
            aria-label="(optional) The suite, apartment number, post office box (etc) associated with your billing address." rel="tooltip"><i class="give-icon give-icon-question"></i></span> </label> <input type="text" id="card_address_2"
          name="card_address_2" autocomplete="address-line2" class="card-address-2 give-input" placeholder="Address line 2" value=""></p>
      <p id="give-card-city-wrap" class="form-row form-row-wide"> <label for="card_city" class="give-label"> City <span class="give-required-indicator ">*</span> <span class="give-tooltip hint--top hint--bounce"
            aria-label="The city for your billing address." rel="tooltip"><i class="give-icon give-icon-question"></i></span> </label> <input type="text" id="card_city" name="card_city" autocomplete="address-level2"
          class="card-city give-input required" placeholder="City" value="" required="" aria-required="true"></p>
      <p id="give-card-state-wrap" class="form-row form-row-first form-row-responsive  "> <label for="card_state" class="give-label"> <span class="state-label-text">Province</span> <span class="give-required-indicator  ">*</span> <span
            class="give-tooltip hint--top hint--medium" data-tooltip="The state, province, or county for your billing address." aria-label="The state, province, or county for your billing address."><i class="give-icon give-icon-question"></i></span>
        </label> <select name="card_state" autocomplete="address-level1" id="card_state" class="card_state give-select required" required="" aria-required="true">
          <option value="" selected="selected"></option>
          <option value="AB">Alberta</option>
          <option value="BC">British Columbia</option>
          <option value="MB">Manitoba</option>
          <option value="NB">New Brunswick</option>
          <option value="NL">Newfoundland and Labrador</option>
          <option value="NS">Nova Scotia</option>
          <option value="NT">Northwest Territories</option>
          <option value="NU">Nunavut</option>
          <option value="ON">Ontario</option>
          <option value="PE">Prince Edward Island</option>
          <option value="QC">Quebec</option>
          <option value="SK">Saskatchewan</option>
          <option value="YT">Yukon</option>
        </select></p>
      <p id="give-card-zip-wrap" class="form-row form-row-last form-row-responsive"> <label for="card_zip" class="give-label"> Zip / Postal Code <span class="give-required-indicator">*</span> <span
            class="give-tooltip hint--top hint--medium hint--bounce" aria-label="The zip or postal code for your billing address." rel="tooltip"><i class="give-icon give-icon-question"></i></span> </label> <input type="text" size="4" id="card_zip"
          name="card_zip" autocomplete="postal-code" class="card-zip give-input required" placeholder="Zip / Postal Code" value="" required="" aria-required="true"></p>
    </fieldset>
    <fieldset id="give_purchase_submit" class="give-donation-submit">
      <p id="give-final-total-wrap" class="form-wrap "> <span class="give-donation-total-label"> Donation Total: </span> <span class="give-final-total-amount" data-total="35"> $35 </span> <span id="give-recurring-modal-period-wrap"
          class="give-hidden"><span id="give-recurring-modal-period">One Time</span></span></p> <input type="hidden" name="give_action" value="purchase"> <input type="hidden" name="give-gateway" value="paypalpro_payflow">
      <div class="give-submit-button-wrap give-clearfix"> <input type="submit" class="give-submit give-btn" id="give-purchase-button" name="give-purchase" value="Donate Now" data-before-validation-label="Donate Now"> <span
          class="give-loading-animation"></span></div>
    </fieldset>
  </div>
</form>

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an arke trust collaborative



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