www.weareplannedparenthoodaction.org
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45.60.33.183
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Submitted URL: https://click.everyaction.com/k/99380137/519757200/1362412928?test=true&seg=OT&sourceid=1017782&ms=4NIAzzzzzX1ANz&...
Effective URL: https://www.weareplannedparenthoodaction.org/33TbASESBEGoNyjHk8Rvew2?test=true&%3bseg=OT&%3bsourceid=1017782&%3bms=4NIAzzzzzX1ANz&am...
Submission: On December 30 via api from US — Scanned from DK
Effective URL: https://www.weareplannedparenthoodaction.org/33TbASESBEGoNyjHk8Rvew2?test=true&%3bseg=OT&%3bsourceid=1017782&%3bms=4NIAzzzzzX1ANz&am...
Submission: On December 30 via api from US — Scanned from DK
Form analysis 1 forms found in the DOM
POST
<form class="clearfix" method="post" novalidate="" action="" accept-charset="utf-8" autocomplete="on">
<div class="at-markup FastAction" id="NVContributionForm2077894-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="NVContributionForm2077894-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="NVContributionForm2077894-ContributionInformation-SelectedFrequency">
<div class="radios" role="radiogroup" aria-labelledby="NVContributionForm2077894-ContributionInformation-SelectedFrequency">
<label title="One-Time" class="at-radio-label-0" role="radio" aria-checked="false">
<input type="radio" name="SelectedFrequency" checked="" value="0"> One-Time </label><label title="Monthly" class="at-radio-label-4" role="radio" aria-checked="true">
<input type="radio" name="SelectedFrequency" value="4"> Monthly </label>
<div class="radio-description radio-description-value-0">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="NVContributionForm2077894-ContributionInformation-SelectAmount">
<div class="at-row SelectAmount OtherAmount NonRecurringButtons">
<div class="at-radio">
<div class="at-radios clearfix">
<label class="label-amount" title="$200">
<input name="SelectAmount" type="radio" value="200.00"> $200 <a></a> </label><label class="label-amount" title="$100">
<input name="SelectAmount" type="radio" value="100.00"> $100 <a></a> </label><label class="label-amount" title="$60">
<input name="SelectAmount" type="radio" value="60.00"> $60 <a></a> </label><label class="label-amount" title="$35">
<input name="SelectAmount" type="radio" value="35.00"> $35 <a></a> </label><label class="label-amount label-otheramount" title="Other">
<input name="SelectAmount" type="radio" class="radio-other" value="other"> Other <input type="number" tabindex="-1" autocomplete="transaction-amount" class="edit-otheramount" name="OtherAmount" title="Other Amount"
placeholder="0.00">
<span class="label-otheramount-prefix">$</span>
</label>
</div>
</div>
</div>
</div>
</div><label class="at-check CoverCostsAmount" id="NVContributionForm2077894-ContributionInformation-CoverCostsAmount"><input type="checkbox" name="CoverCostsAmount" class="ccDef"> <span class="at-checkbox-title-container"><span
class="at-checkbox-title" id="NVContributionForm2077894-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">$103.25</span>, so <span class="amCon">$100.00</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 another option
above.</div>
</fieldset>
<fieldset class="at-fieldset PaymentMethodSection" id="NVContributionForm2077894-PaymentMethodSection">
<div class="at-fields">
<div class="at-row at-row-full PaymentMethod">
<div class="at-payment-method-buttons" id="NVContributionForm2077894-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_2077894" type="radio" name="PaymentMethod" value="creditcard">
<label for="creditcard_radio_2077894" 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_2077894" type="radio" name="PaymentMethod" value="eft">
<label for="eft_radio_2077894" 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_2077894" type="radio" name="PaymentMethod" value="paypal">
<label for="paypal_radio_2077894" 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="NVContributionForm2077894-ContactInformation" style="display: none;">
<legend class="at-legend">Contact Information</legend>
<div class="at-fields">
<div class="at-row FirstName LastName"><label class="at-text FirstName" id="NVContributionForm2077894-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="NVContributionForm2077894-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="NVContributionForm2077894-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="NVContributionForm2077894-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="NVContributionForm2077894-ContactInformation-Country">Country <small>(Optional)</small><select autocomplete="country-name"
x-autocompletetype="country" title="Country" name="Country" class="select2-hidden-accessible" id="NVContributionForm2077894-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-NVContributionForm2077894-ContactInformation-Country-select-container"><span class="select2-selection__rendered"
id="select2-NVContributionForm2077894-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="NVContributionForm2077894-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="NVContributionForm2077894-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="NVContributionForm2077894-ContactInformation-StateProvince">State/Province<select required="" autocomplete="address-level1" x-autocompletetype="administrative-area" title="State/Province"
name="StateProvince" class=" required" id="NVContributionForm2077894-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="NVContributionForm2077894-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="NVContributionForm2077894-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="NVContributionForm2077894-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.plannedparenthoodaction.org/about-us/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="NVContributionForm2077894-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="NVContributionForm2077894-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="NVContributionForm2077894-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="NVContributionForm2077894-ContactInformation-TrackingPixel" style="display: none;"><img alt=""
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</fieldset>
<fieldset class="at-fieldset PaymentInformation" id="NVContributionForm2077894-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="NVContributionForm2077894-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-2077894" 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=randomId3001738050894191201&fieldId=randomId30002386300992911128&createdAt=1735560131082&tnt=dG50dzFwem5sYW0%3D&env=bGl2ZQ%3D%3D&logLevel=default&satellitePort=&vgsCollectSessionId=fa15faa4-e663-4510-8e76-384d44b2ebc9&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="randomId30002386300992911128" form-id="randomId3001738050894191201" 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="NVContributionForm2077894-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-2077894" 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=randomId3001738050894191201&fieldId=randomId3006115885126577845&createdAt=1735560131083&tnt=dG50dzFwem5sYW0%3D&env=bGl2ZQ%3D%3D&logLevel=default&satellitePort=&vgsCollectSessionId=fa15faa4-e663-4510-8e76-384d44b2ebc9&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="randomId3006115885126577845" form-id="randomId3001738050894191201" 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="NVContributionForm2077894-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>
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</div>
<div class="at-row">
<div class="at-paypal-accepted-here" style="display: none;">
<div class="at-payment-integration-container" style="display: none;">
<img class="at-paypal-logo-img" src="//static.everyaction.com/ea-actiontag/assets/images/paypal-logo.png" alt="PayPal">
<p class="at-paypal-authorized-text">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="">
<input type="hidden" name="payPalNonceType" 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="NVContributionForm2077894-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="NVContributionForm2077894-AdditionalInformation-CustomFieldHeaderHtml" style="display: none;"></div>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_206352670991819_MappedCustomFormFieldQuestion_46">
<label class="at-text CustomFormFieldQuestion_206352670991819_MappedCustomFormFieldQuestion_46" id="NVContributionForm2077894-AdditionalInformation-CustomFormFieldQuestion_206352670991819_MappedCustomFormFieldQuestion_46">Salesforce Code
<small>(Optional)</small><input type="text" autocomplete="on" false="" title="Salesforce Code" name="CustomFormFieldQuestion_206352670991819_MappedCustomFormFieldQuestion_46" value="" maxlength="75">
</label>
</div>
<div class="at-row at-row-full CustomFieldFooterHtml">
<div class="at-markup CustomFieldFooterHtml" id="NVContributionForm2077894-AdditionalInformation-CustomFieldFooterHtml" style="display: none;"></div>
</div>
</div>
</fieldset>
<div class="at-form-submit clearfix">
<input type="submit" value="Donate Now" class="at-submit btn-at btn-at-primary" style="display: none;">
<div class="at-markup secure-processing-single-step-div" style="display: none;">
<label class="secure-processing-label at-text"> Your donation will be securely processed.<div class="glyphicons glyphicons-lock" aria-hidden="true"></div>
</label>
</div>
<div id="PrivacyPolicy" style="display: block;">
<p class="legal">Planned Parenthood Action Fund respects your privacy, and works to ensure your information is kept confidential. Feel free to review our
<a href="https://www.plannedparenthoodaction.org/about-us/privacy-policy" target="_blank" title="Privacy Policy">privacy policy</a> and our website's
<a href="https://www.plannedparenthoodaction.org/about-us/terms-use" target="_blank" title="Terms of Use">terms of use</a>, and <a href="https://www.plannedparenthoodaction.org/donor-services" target="_blank" title="Contact Us">reach out</a>
with any questions.</p>
</div>
</div>
</form>Text Content
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