www.weareplannedparenthood.org
Open in
urlscan Pro
45.60.33.183
Public Scan
Submitted URL: http://www.weareplannedparenthood.org/onlineactions/H8h-OMpbvEm9bRKX6BnDxw2?sourceid=1015332%26ms=3NALzzz00z1N1A%26utm_campaign=3NIAU2...
Effective URL: https://www.weareplannedparenthood.org/onlineactions/H8h-OMpbvEm9bRKX6BnDxw2?sourceid=1015332%26ms=3NALzzz00z1N1A%26utm_campaign=3NIAU2...
Submission: On January 25 via api from US — Scanned from DE
Effective URL: https://www.weareplannedparenthood.org/onlineactions/H8h-OMpbvEm9bRKX6BnDxw2?sourceid=1015332%26ms=3NALzzz00z1N1A%26utm_campaign=3NIAU2...
Submission: On January 25 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST v1
<form class="clearfix" method="post" novalidate="" action="v1" accept-charset="utf-8" autocomplete="on">
<div class="at-markup FastAction" id="NVContributionForm81561-FastAction">
<div class="fastaction-block">
<div class="fastAction clearfix">
<p>
<span class="fa-cta">
<a href="#fastaction-login" class="profile-link" aria-label="FastAction">
<img class="profile-link-fa-image" src="//static.everyaction.com/ea-actiontag/assets/images/fast-action.svg" alt="Fast Action Logo">
</a>
<span><a href="https://fastaction.ngpvan.com##whats-this" class="circle" id="fastaction-whatsthis" data-popup="true" data-popup-width="515" data-popup-height="540" target="_blank">?</a></span>
</span>
<span class="fa-lead"> Take future action with a single click.<br>
<a href="#fastaction-login" class="call-modal" id="fastaction-widget-login">Log in</a> or <a href="#fastaction-signup" class="call-modal" id="fastaction-widget-signup">Sign up</a> for <i>Fast</i><b>Action</b>
</span>
</p>
</div>
</div>
</div>
<div data-name="undefined" data-subview="submit_view" data-subview-index="2"></div>
<fieldset class="at-fieldset ContributionInformation" id="NVContributionForm81561-ContributionInformation">
<legend class="at-legend">Gift Information</legend>
<div class="at-fields">
<div class="at-row at-row-full ">
<div class="form-unit form-unit-radio form-item-selectedfrequency" id="NVContributionForm81561-ContributionInformation-SelectedFrequency">
<div class="radios" role="radiogroup" aria-labelledby="NVContributionForm81561-ContributionInformation-SelectedFrequency">
<label title="One-Time" class="at-radio-label-0" role="radio" aria-checked="true">
<input type="radio" name="SelectedFrequency" value="0"> One-Time </label><label title="Monthly" class="at-radio-label-4" role="radio" aria-checked="false">
<input type="radio" name="SelectedFrequency" checked="" value="4"> Monthly </label>
<div class="radio-description radio-description-value-4">A monthly gift does even more to protect reproductive rights</div>
</div>
</div>
</div>
<div class="at-row at-row-full ">
<input id="ProcessingCurrency_Value" type="hidden" name="ProcessingCurrency.Value" value="USD">
</div>
<div class="at-row at-row-full ">
<div class="form-item form-type-radios form-item-selectamount" id="NVContributionForm81561-ContributionInformation-SelectAmount">
<div class="at-row SelectAmount OtherAmount NonRecurringButtons">
<div class="at-radio">
<div class="at-radios clearfix">
<label class="label-amount" title="$50">
<input name="SelectAmount" type="radio" value="50.00"> $50 <a></a> </label><label class="label-amount" title="$35">
<input name="SelectAmount" type="radio" value="35.00"> $35 <a></a> </label><label class="label-amount" title="$25">
<input name="SelectAmount" type="radio" value="25.00"> $25 <a></a> </label><label class="label-amount" title="$15">
<input name="SelectAmount" type="radio" value="15.00"> $15 <a></a> </label><label class="label-amount label-otheramount" title="Other">
<input name="SelectAmount" type="radio" class="radio-other" value="other"> Other <input type="number" tabindex="-1" autocomplete="transaction-amount" class="edit-otheramount" name="OtherAmount" title="Other Amount"
placeholder="0.00">
<span class="label-otheramount-prefix">$</span>
</label>
</div>
</div>
</div>
</div>
</div><label class="at-check CoverCostsAmount" id="NVContributionForm81561-ContributionInformation-CoverCostsAmount"><input type="checkbox" name="CoverCostsAmount" class="ccDef"> <span class="at-checkbox-title-container"><span
class="at-checkbox-title" id="NVContributionForm81561-ContributionInformation-CoverCostsAmount-label">I'd like to help cover the transaction fees for my contribution</span><span>I'd like to cover the processing fees, making my total gift
<span class="contr">$36.14</span>, so <span class="amCon">$35.00</span> goes to protect reproductive health.</span></span>
</label>
</div>
<div id="monthlyWarn" style="display: none; padding-bottom: 24px; padding-left: 12px; color: #c9084c;">You are making a monthly gift of $<span id="monthlyWarnAmount"></span>. If you do not want to make a monthly gift, please select "One-Time"
above.</div>
</fieldset>
<fieldset class="at-fieldset PaymentMethodSection" id="NVContributionForm81561-PaymentMethodSection">
<div class="at-fields">
<div class="at-row at-row-full PaymentMethod">
<div class="at-payment-method-buttons" id="NVContributionForm81561-PaymentMethodSection-PaymentMethod">
<div class="at-radio-set at-radio-set-buttons at-align-flex-right">
<div class="at-btn-radio-wrapper at-credit-card-button-wrapper">
<input id="creditcard_radio_81561" type="radio" name="PaymentMethod" value="creditcard">
<label for="creditcard_radio_81561" class="at-btn-radio large" tabindex="0">Credit Card</label>
</div>
<div class="at-btn-radio-wrapper at-eft-button-wrapper">
<input id="eft_radio_81561" type="radio" name="PaymentMethod" value="eft">
<label for="eft_radio_81561" class="at-btn-radio large" tabindex="0"> Pay with Bank Account </label>
</div>
<div class="at-btn-radio-wrapper at-paypal-button-wrapper">
<input id="paypal_radio_81561" type="radio" name="PaymentMethod" value="paypal">
<label for="paypal_radio_81561" class="at-btn-radio small at-paypal-button" title="Pay with PayPal" aria-label="Pay with PayPal" tabindex="0">
<span aria-hidden="true"> </span>
</label>
</div>
</div>
</div>
</div>
</div>
</fieldset>
<fieldset class="at-fieldset ContactInformation" id="NVContributionForm81561-ContactInformation" style="display: none;">
<legend class="at-legend">Billing Information</legend>
<div class="at-fields">
<div class="at-row FirstName LastName"><label class="at-text FirstName" id="NVContributionForm81561-ContactInformation-FirstName">First Name<input type="text" autocomplete="given-name" x-autocompletetype="given-name" required=""
title="First Name (required)" name="FirstName" value="" maxlength="20">
</label><label class="at-text LastName" id="NVContributionForm81561-ContactInformation-LastName">Last Name<input type="text" autocomplete="family-name" x-autocompletetype="surname" required="" title="Last Name (required)" name="LastName"
value="" maxlength="25">
</label></div>
<div class="at-row AddressLine1 AddressLine2"><label class="at-text AddressLine1" id="NVContributionForm81561-ContactInformation-AddressLine1">Street Address<input type="text" autocomplete="address-line1" x-autocompletetype="address-line1"
required="" title="Street Address (required)" name="AddressLine1" value="" maxlength="99">
</label><label class="at-text AddressLine2" id="NVContributionForm81561-ContactInformation-AddressLine2">Address Line 2 <small>(Optional)</small><input type="text" autocomplete="address-line2" x-autocompletetype="address-line2" false=""
title="Address Line 2" name="AddressLine2" value="" maxlength="99">
</label></div>
<div class="at-row Country PostalCode City StateProvince"><label class="at-select Country" id="NVContributionForm81561-ContactInformation-Country">Country <small>(Optional)</small><select autocomplete="country-name" x-autocompletetype="country"
title="Country" name="Country" class="select2-hidden-accessible" id="NVContributionForm81561-ContactInformation-Country-select" tabindex="-1" aria-hidden="true">
<option value="">- Select -</option>
<option value="AF">Afghanistan</option>
<option value="AX">Åland Islands</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</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 (Plurinational State of)</option>
<option value="BQ">Bonaire, Sint Eustatius and Saba</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="VG">British Virgin Islands</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="CV">Cabo Verde</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</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 (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CD">Congo (Democratic Republic of the)</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Côte d'Ivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CW">Curaçao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czechia</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="SZ">Eswatini</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands (Malvinas)</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="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</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 Island and McDonald Islands</option>
<option value="VA">Holy See</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 (Islamic Republic of)</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="KP">Korea (Democratic People's Republic of)</option>
<option value="KR">Korea (Republic of)</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">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macao</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="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 (Federated States of)</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="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="MK">North Macedonia</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestine (State of)</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</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="QA">Qatar</option>
<option value="RE">Réunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="BL">Saint Barthélemy</option>
<option value="SH">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="MF">Saint Martin (French part)</option>
<option value="PM">Saint Pierre and Miquelon</option>
<option value="VC">Saint Vincent and the Grenadines</option>
<option value="WS">Samoa</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="SX">Sint Maarten (Dutch part)</option>
<option value="SK">Slovakia</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 and the South Sandwich Islands</option>
<option value="SS">South Sudan</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</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 (United Republic of)</option>
<option value="TH">Thailand</option>
<option value="TL">Timor-Leste</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</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="GB">United Kingdom</option>
<option value="US">United States</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VE">Venezuela (Bolivarian Republic of)</option>
<option value="VN">Viet Nam</option>
<option value="WF">Wallis and Futuna</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 264px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox" aria-haspopup="true"
aria-expanded="false" title="Country" tabindex="0" aria-labelledby="select2-NVContributionForm81561-ContactInformation-Country-select-container"><span class="select2-selection__rendered"
id="select2-NVContributionForm81561-ContactInformation-Country-select-container" title="United States">United States</span><span class="select2-selection__arrow"
role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</label><label class="at-text PostalCode" id="NVContributionForm81561-ContactInformation-PostalCode">Postal Code<input type="tel" autocomplete="postal-code" x-autocompletetype="postal-code" pattern="^\d{5}([\-]\d{4})?$" required=""
title="Postal Code (required)" name="PostalCode" value="" maxlength="10">
</label><label class="at-text City" id="NVContributionForm81561-ContactInformation-City">City<input type="text" autocomplete="address-level2" x-autocompletetype="locality" required="" title="City (required)" name="City" value=""
maxlength="25">
</label><label class="at-select StateProvince" id="NVContributionForm81561-ContactInformation-StateProvince">State/Province<select required="" autocomplete="address-level1" x-autocompletetype="administrative-area" title="State/Province"
name="StateProvince" class=" required" id="NVContributionForm81561-ContactInformation-StateProvince-select">
<option value="" disabled="">- State -</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</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="VA">VA</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
<option value="AS">AS</option>
<option value="FM">FM</option>
<option value="GU">GU</option>
<option value="MH">MH</option>
<option value="MP">MP</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="VI">VI</option>
<option value="AA">AA</option>
<option value="AE">AE</option>
<option value="AP">AP</option>
</select>
</label></div>
<div class="at-row EmailAddress MobilePhone"><label class="at-text EmailAddress" id="NVContributionForm81561-ContactInformation-EmailAddress">Email<input type="email" autocomplete="email" x-autocompletetype="email"
pattern="^([\w!#$%&'*+\-\/=?\^`\{\|\}~]+\.)*[\w!#$%&'*+\-\/=?\^`\{\|\}~]+@((((([a-zA-Z0-9]{1}[a-zA-Z0-9\-]{0,62}[a-zA-Z0-9]{1})|[a-zA-Z])\.)+[a-zA-Z]{2,62})|(\d{1,3}\.){3}\d{1,3}(:\d{1,5})?)$" required="" title="Email (required)"
name="EmailAddress" value="" maxlength="100" placeholder="email@email.com">
</label><label class="at-text MobilePhone" id="NVContributionForm81561-ContactInformation-MobilePhone">Mobile Phone <small>(Optional)</small>
<div class="intl-tel-input iti iti--allow-dropdown">
<div class="iti__flag-container">
<div class="iti__selected-flag" role="combobox" aria-controls="iti-0__country-listbox" aria-owns="iti-0__country-listbox" aria-expanded="false" tabindex="0" title="United States: +1" aria-activedescendant="iti-0__item-us-preferred">
<div class="iti__flag iti__us"></div>
<div class="iti__arrow"></div>
</div>
</div><input type="tel" class="intl-phone-MobilePhone" name="MobilePhone" title="Mobile Phone" data-intl-tel-input-id="0">
</div>
</label></div>
<div class="at-row at-row-solo SmsSubscribeMobilePhone"><input id="SmsSubscribeMobilePhone_Value" type="hidden" name="SmsSubscribeMobilePhone.Value" value="true"></div>
<div class="at-row at-row-solo at-row-full SmsLegalDisclaimer">
<div class="at-markup SmsLegalDisclaimer at-legal" id="NVContributionForm81561-ContactInformation-SmsLegalDisclaimer">By providing your cell phone number, you agree to receive calls and texts to that number from Planned Parenthood
organizations that may be automatically dialed or prerecorded on Planned Parenthood issues and other ways to get involved. Msg freq varies. STOP to quit. Msg & Data Rates May Apply.
<a href="https://www.plannedparenthood.org/terms-use" target="_blank">Terms</a>.<br><br>
</div>
</div>
<div class="at-row at-row-solo at-row-full YesSignMeUpForUpdatesForBinder"><label class="at-check YesSignMeUpForUpdatesForBinder YesSignMeUpForUpdatesForBinder-hidden"
id="NVContributionForm81561-ContactInformation-YesSignMeUpForUpdatesForBinder"><input type="checkbox" checked="" required="" name="YesSignMeUpForUpdatesForBinder"> <span class="at-checkbox-title-container at-legal"
style="cursor: initial;"><span class="at-checkbox-title at-legal" id="NVContributionForm81561-ContactInformation-YesSignMeUpForUpdatesForBinder-label" style="cursor: initial;">You'll receive emails from Planned Parenthood organizations.
You may unsubscribe at any time.</span></span>
</label></div>
<div class="at-row "><label class="at-text PersonalUrl" id="NVContributionForm81561-ContactInformation-PersonalUrl"> <small>(Optional)</small><input type="text" autocomplete="on" false="" title="" name="PersonalUrl" value="" maxlength="">
</label></div>
<div class="at-row "><input id="SocialNetworkTrackingId_Value" type="hidden" name="SocialNetworkTrackingId.Value"></div>
<div class="at-row "><input id="SocialNetwork_Value" type="hidden" name="SocialNetwork.Value"></div>
<div class="at-row ">
<div class="at-markup TrackingPixel" id="NVContributionForm81561-ContactInformation-TrackingPixel" style="display: none;"><img alt=""
src="https://secure.everyaction.com/v1/Track/H8h-OMpbvEm9bRKX6BnDxw2?sourceid=1015332%26ms%3D3NALzzz00z1N1A%26utm_campaign%3D3NIAU23XA_0000000124_8E1NCR%26utm_source%3DQuantcast%26utm_medium%3Ddisplay%26dclid%3DCLeO_tqb94MDFTzHwgQd5swPtQ%26vmcid%3D&formSessionId=848f7dd3-fc36-45bb-9634-b19e437215b1&bName=chrome&dType=desktop&formVersion=8/17/2023 5:50:38 PM|11/28/2023 1:54:06 AM&fUrl=aHR0cHM6Ly93d3cud2VhcmVwbGFubmVkcGFyZW50aG9vZC5vcmcvb25saW5lYWN0aW9ucy9IOGgtT01wYnZFbTliUktYNkJuRHh3Mj9zb3VyY2VpZD0xMDE1MzMyJTI2bXM9M05BTHp6ejAwejFOMUElMjZ1dG1fY2FtcGFpZ249M05JQVUyM1hBXzAwMDAwMDAxMjRfOEUxTkNSJTI2dXRtX3NvdXJjZT1RdWFudGNhc3QlMjZ1dG1fbWVkaXVtPWRpc3BsYXklMjZkY2xpZD1DTGVPX3RxYjk0TURGVHpId2dRZDVzd1B0USUyNnZtY2lkPQ%3D%3D&fRef="
style="display:none"></div>
</div>
</div>
</fieldset>
<fieldset class="at-fieldset PaymentInformation" id="NVContributionForm81561-PaymentInformation" style="display: none;">
<legend class="at-legend">Payment Information</legend>
<div class="at-fields">
<div class="at-row "><label class="at-text at-cc-number" id="NVContributionForm81561-PaymentInformation-Account">Card Number<div class="cc-type-wrapper vgs-loading-placeholder" style="display: none;">
<div class="cc-type unknown"></div>
<input type="tel" autocomplete="cc-number" title="Credit Card Number" placeholder="•••• •••• •••• ••••" readonly="true">
</div>
<div id="vgs-Account-81561" class="vgs-cc-iframe-wrapper vgs-input-container vgs-collect-container__empty vgs-collect-container__invalid isEmpty" tabindex="-1"><iframe title="Secure card number input frame"
src="https://js.verygoodvault.com/vgs-collect/2.18.4/lib/index.html#name=Account&placeholder=%E2%80%A2%E2%80%A2%E2%80%A2%E2%80%A2%20%E2%80%A2%E2%80%A2%E2%80%A2%E2%80%A2%20%E2%80%A2%E2%80%A2%E2%80%A2%E2%80%A2%20%E2%80%A2%E2%80%A2%E2%80%A2%E2%80%A2&type=card-number&validations%5B0%5D=validCardNumber&validations%5B1%5D=required&autoComplete=cc-number&formId=randomId2502291785848383605&fieldId=randomId25008243938097520509&createdAt=1706141395517&tnt=dG50dzFwem5sYW0%3D&env=bGl2ZQ%3D%3D&logLevel=default&satellitePort=&vgsCollectSessionId=236377c0-2285-4b6f-82a1-11597bdc40f5&css%5BfontSize%5D=.875rem&css%5BfontFamily%5D=monospace&css%5BlineHeight%5D=1&css%5BbackgroundColor%5D=%23fff&css%5B%26%3A%3Aplaceholder%5D%5Bcolor%5D=%23ced4da&css%5B%26%3A%3Aplaceholder%5D%5BfontWeight%5D=bold"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId25008243938097520509" form-id="randomId2502291785848383605" data-gtm-yt-inspected-666187_821="true" data-gtm-yt-inspected-61934708_454="true"></iframe></div>
</label><label class="at-text at-cc-expiration" id="NVContributionForm81561-PaymentInformation-ExpirationDate">Expiration Date<div class="vgs-loading-placeholder" style="display: none;">
<input type="tel" autocomplete="cc-exp" title="Expiration Date (MM / YY)" placeholder="MM / YY" readonly="true">
</div>
<div id="vgs-ExpirationDate-81561" class="vgs-ccexpiration-iframe-wrapper vgs-input-container vgs-collect-container__empty vgs-collect-container__invalid isEmpty"><iframe title="Secure card expiration date input frame"
src="https://js.verygoodvault.com/vgs-collect/2.18.4/lib/index.html#name=ExpirationDate&placeholder=MM%20%2F%20YY&type=card-expiration-date&serializers=W3sibmFtZSI6InNlcGFyYXRlIiwib3B0aW9ucyI6eyJtb250aE5hbWUiOiJFeHBpcmF0aW9uTW9udGgiLCJ5ZWFyTmFtZSI6IkV4cGlyYXRpb25ZZWFyIn19XQ%3D%3D&validations%5B0%5D=validCardExpirationDate&validations%5B1%5D=required&autoComplete=cc-exp&formId=randomId2502291785848383605&fieldId=randomId2502905707326566087&createdAt=1706141395519&tnt=dG50dzFwem5sYW0%3D&env=bGl2ZQ%3D%3D&logLevel=default&satellitePort=&vgsCollectSessionId=236377c0-2285-4b6f-82a1-11597bdc40f5&css%5BfontSize%5D=.875rem&css%5BfontFamily%5D=monospace&css%5BlineHeight%5D=1&css%5BbackgroundColor%5D=%23fff&css%5B%26%3A%3Aplaceholder%5D%5Bcolor%5D=%23ced4da&css%5B%26%3A%3Aplaceholder%5D%5BfontWeight%5D=bold"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId2502905707326566087" form-id="randomId2502291785848383605" data-gtm-yt-inspected-666187_821="true" data-gtm-yt-inspected-61934708_454="true"></iframe></div>
</label></div>
<div class="at-row ">
<div class="at-markup UpdateMyProfile at-mode-person-only" id="NVContributionForm81561-PaymentInformation-UpdateMyProfile">
<div class="updateMyProfileSection" style=""><label style="display:inline;"><input type="checkbox" name="updateMyProfile" checked="checked"><span><span class="text">Remember me so that I can use <i>Fast</i><b>Action</b> next
time.</span></span></label></div>
</div>
</div>
<div class="at-row">
<div class="at-paypal-accepted-here" style="display: none;">
<div class="at-payment-integration-container" style="display: none;">
<img src="//static.everyaction.com/ea-actiontag/assets/images/paypal-logo.png" alt="PayPal">
<p>You’ve authorized this payment through PayPal.</p>
<div>Contribution Amount: <b class="at-paypal-amount"></b></div>
<div>Account: <b class="at-paypal-account-info"></b></div>
</div>
<label class="paypal-label">
<input type="hidden" name="paypalNonce" value="">
</label>
</div>
</div>
<div class="at-row">
<div class="at-eft-accepted-here" style="display: none;">
<label class="account-type-label">Account Type <select title="Account Type" name="bankAccountType" id="bankAccountType" style="width:50%;" class="eft-input">
<option value="Checking">Checking</option>
<option value="Savings">Savings</option>
</select>
</label>
<label class="routing-number-label at-row-half">Routing Number <a class="at-whatsthis" tabindex="0">What's This?</a>
<input type="tel" name="routingNumber" id="routingNumber" placeholder="•••••••••" style="width:100%;" maxlength="9" class="eft-input">
</label>
<label class="account-number-label at-row-half">Account Number <a class="at-whatsthis" tabindex="0">What's This?</a>
<input type="tel" name="bankAccountNumber" id="bankAccountNumber" placeholder="•••••••••••••••••" style="width:100%;" maxlength="17" class="eft-input">
</label>
<label class="confirm-account-number-label at-row-half">Confirm Account Number <input type="tel" name="confirmBankAccountNumber" id="confirmBankAccountNumber" placeholder="•••••••••••••••••" style="width:100%;" maxlength="17"
class="eft-input">
</label>
<label class="at-check authorize-payment-label">
<input type="checkbox" name="authorizePayment" id="authorizePayment" class="eft-input">
<span>I authorize the use of my bank account as a payment method and authorize this organization to debit my bank account via the Automated Clearing House system to fulfill my donation commitment. This authority will remain in effect
until revoked in writing by the account holder.</span>
</label>
</div>
</div>
</div>
</fieldset>
<fieldset class="at-fieldset AdditionalInformation" id="NVContributionForm81561-AdditionalInformation" style="display: none;">
<legend class="at-legend">Additional Information</legend>
<div class="at-fields">
<div class="at-row at-row-full CustomFieldHeaderHtml">
<div class="at-markup CustomFieldHeaderHtml" id="NVContributionForm81561-AdditionalInformation-CustomFieldHeaderHtml" style="display: none;"></div>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_6308388360774211_MappedCustomFormFieldQuestion_39">
<label class="at-text CustomFormFieldQuestion_6308388360774211_MappedCustomFormFieldQuestion_39" id="NVContributionForm81561-AdditionalInformation-CustomFormFieldQuestion_6308388360774211_MappedCustomFormFieldQuestion_39">Affiliate Code
<small>(Optional)</small><input type="text" autocomplete="on" false="" title="Affiliate Code" name="CustomFormFieldQuestion_6308388360774211_MappedCustomFormFieldQuestion_39" value="" maxlength="75">
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_3612949719869257_MappedCustomFormFieldQuestion_40">
<label class="at-text CustomFormFieldQuestion_3612949719869257_MappedCustomFormFieldQuestion_40" id="NVContributionForm81561-AdditionalInformation-CustomFormFieldQuestion_3612949719869257_MappedCustomFormFieldQuestion_40">Affiliate
Percentage <small>(Optional)</small><input type="text" autocomplete="on" pattern="^(\d+(\.\d{0,2})?)|((\.\d{1,2}))$" false="" title="Affiliate Percentage" name="CustomFormFieldQuestion_3612949719869257_MappedCustomFormFieldQuestion_40"
value="" maxlength="">
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_5727351705861509_MappedCustomFormFieldQuestion_46">
<label class="at-text CustomFormFieldQuestion_5727351705861509_MappedCustomFormFieldQuestion_46" id="NVContributionForm81561-AdditionalInformation-CustomFormFieldQuestion_5727351705861509_MappedCustomFormFieldQuestion_46">Salesforce Code
<small>(Optional)</small><input type="text" autocomplete="on" false="" title="Salesforce Code" name="CustomFormFieldQuestion_5727351705861509_MappedCustomFormFieldQuestion_46" value="" maxlength="75">
</label>
</div>
<div class="at-row at-row-full CustomFieldFooterHtml">
<div class="at-markup CustomFieldFooterHtml" id="NVContributionForm81561-AdditionalInformation-CustomFieldFooterHtml" style="display: none;"></div>
</div>
</div>
</fieldset>
<div class="at-form-submit clearfix">
<input type="submit" value="Donate Monthly Now" class="at-submit btn-at btn-at-primary" style="display: none;">
<div id="PrivacyPolicy" style="display: block;">
<p class="legal">Planned Parenthood respects your privacy, and works to ensure your information is kept confidential. Feel free to review our
<a href="https://www.plannedparenthood.org/privacy-policy" target="_blank" title="Privacy Policy">privacy policy</a> and our website's
<a href="https://www.plannedparenthood.org/terms-use" target="_blank" title="Terms of Use">terms of use</a>, and <a href="https://www.plannedparenthood.org/donor-services" target="_blank" title="Contact Us">reach out</a> with any questions.
</p>
<p>
<img class="seal" src="https://nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Themes/Evergreen/Web/Seals/seal_CharityNav.png" alt="Charity Navigator Four Star Charity">
<img class="seal" src="https://nvlupin.blob.core.windows.net/images/van/AV/PPFA/1/11607/images/Themes/Evergreen/Web/Seals/seal_BBB.png" alt="Better Business Bureau Accredited Charity">
</p>
<div class="hide-for-medium">
<p class="small specific-giving-promo">Prefer to direct your gift to the Planned Parenthood organization of your choice? <a href="https://www.weareplannedparenthood.org/onlineactions/cOJVhOyrzkq4uBcxVekXFA2">Visit Specific Giving.</a></p>
</div>
</div>
</div>
</form>Text Content
I'd like an e-card to be sent via email (delivered instantly or on a specific date of your choosing) I'd like a physical card to be sent via the mail (delivered within 2 - 3 weeks) Planned Parenthood needs you. PROTECT AND RESTORE ABORTION ACCESS. PLANNED PARENTHOOD NEEDS YOU — GIVE NOW. From the Supreme Court to statehouses nationwide, the right to control our bodies is under attack like never before. Together, we must protect and restore access to sexual and reproductive health care, including abortion. Help Planned Parenthood stand up for patients and protect our rights. Make your tax-deductible gift today so we can continue to protect and provide care, no matter what. Prefer to direct your gift to the Planned Parenthood organization of your choice? Visit Specific Giving. LOOKING FOR CARE? Find a Health Center Your gift will be shared between your local Planned Parenthood affiliate and Planned Parenthood Federation of America. ? Take future action with a single click. Log in or Sign up for FastAction Gift Information One-Time Monthly A monthly gift does even more to protect reproductive rights $50 $35 $25 $15 Other $ I'd like to help cover the transaction fees for my contributionI'd like to cover the processing fees, making my total gift $36.14, so $35.00 goes to protect reproductive health. You are making a monthly gift of $. If you do not want to make a monthly gift, please select "One-Time" above. Credit Card Pay with Bank Account Billing Information First Name Last Name Street Address Address Line 2 (Optional) Country (Optional)- Select -AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuela (Bolivarian Republic of)Viet NamWallis and FutunaWestern SaharaYemenZambiaZimbabweUnited States Postal Code City State/Province- State -AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYASFMGUMHMPPRPWVIAAAEAP Email Mobile Phone (Optional) By providing your cell phone number, you agree to receive calls and texts to that number from Planned Parenthood organizations that may be automatically dialed or prerecorded on Planned Parenthood issues and other ways to get involved. Msg freq varies. STOP to quit. Msg & Data Rates May Apply. Terms. You'll receive emails from Planned Parenthood organizations. You may unsubscribe at any time. (Optional) Payment Information Card Number Expiration Date Remember me so that I can use FastAction next time. You’ve authorized this payment through PayPal. Contribution Amount: Account: Account Type Checking Savings Routing Number What's This? Account Number What's This? Confirm Account Number I authorize the use of my bank account as a payment method and authorize this organization to debit my bank account via the Automated Clearing House system to fulfill my donation commitment. This authority will remain in effect until revoked in writing by the account holder. Additional Information Affiliate Code (Optional) Affiliate Percentage (Optional) Salesforce Code (Optional) Planned Parenthood respects your privacy, and works to ensure your information is kept confidential. Feel free to review our privacy policy and our website's terms of use, and reach out with any questions. Prefer to direct your gift to the Planned Parenthood organization of your choice? Visit Specific Giving. SHOW YOUR SUPPORT WITH A SINGLE CLICK Autofill forms quickly and securely with FastAction Sign up with your email address Already have a FastAction account? Log in By clicking "Log in," I confirm that I agree with the FastAction terms of service and privacy policy. × SHOW YOUR SUPPORT WITH A SINGLE CLICK Autofill forms quickly and securely with FastAction Log in with your email address We have discontinued Facebook and Twitter log in options in favor of ActionID, our newer, single sign-on for all your accounts across our platform. Log in or sign up using your email address to unlock your FastAction profile and take future action with a single click. Don't have a FastAction account yet? Sign up By clicking "Sign up," I confirm that I agree with the FastAction terms of service and privacy policy. × Planned Parenthood needs you. We all deserve the right to make our own health care choices. That's why I just joined Planned Parenthood in the fight to make sure everyone can access the care they need, no matter where they live, no matter what. Stand with us. ABOUT YOUR GIFT P.S. Please know that your contribution is tax-deductible to the fullest extent allowable under the law. IRS regulations require us to state that we did not provide any goods or services to you in consideration of your contribution. You may wish to print or save this message as your receipt for tax purposes. About your Gift Your contribution to PPFA is tax-deductible to the fullest extent allowable. Our federal tax ID number is 13-1644147. Donor Frequently Asked Questions » Financial Report & Registration » Contact Us Contact Donor Services Call 1-800-430-4907 Tax-Deductible Your contribution to PPFA is tax-deductible to the fullest extent allowable under the law. Our federal tax ID number is 13-1644147. Donor FAQ Have a question about your donation? Review our Donor Frequently Asked Questions. Contact Us Contact Donor Services Call 1-800-430-4907 Financial Information Get more information, including how to obtain a copy of our latest Financial Report & Registration. Planned Parenthood delivers vital reproductive health care, sex education, and information to millions of people worldwide. * Privacy Policy * Terms of Use * Contact Us © 2024 Planned Parenthood Federation of America Inc.