www.telegraphherald.com
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192.104.183.109
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URL:
https://www.telegraphherald.com/news/tri-state/article_cc48af36-ab4b-11ee-93fb-b78c101851bb.html
Submission: On January 06 via manual from US — Scanned from US
Submission: On January 06 via manual from US — Scanned from US
Form analysis 22 forms found in the DOM
GET /search/
<form id="site-search-1009961" aria-label="Site search" action="/search/" method="GET">
<input type="hidden" name="l" value="25">
<input type="hidden" name="sort" value="relevance">
<input type="hidden" name="f" value="html">
<input type="hidden" name="t" value="article,video,youtube,collection">
<input type="hidden" name="app" value="editorial">
<input type="hidden" name="nsa" value="eedition">
<div id="site-search-form-1009961" class="site-search-form input-group default normal ">
<label for="site-search-1009961-term" class="sr-only">Site search</label>
<input id="site-search-1009961-term" name="q" title="Site search" type="text" placeholder="Search..." class="form-control" autocomplete="off">
<input type="submit" class="hide" value="Search">
<span class="input-group-btn">
<button id="site-search-1009961-btn" class="btn btn-primary" aria-label="Submit Site Search" type="submit">
<svg class="tnt-svg tnt-search tnt-w-16 hidden-xl hidden-lg hidden-md" aria-hidden="true" data-prefix="fas" data-icon="search" role="presentation" xmlns="https://www.w3.org/2000/svg" viewBox="0 0 512 512" data-fa-i2svg="">
<path fill="currentColor"
d="M505 442.7L405.3 343c-4.5-4.5-10.6-7-17-7H372c27.6-35.3 44-79.7 44-128C416 93.1 322.9 0 208 0S0 93.1 0 208s93.1 208 208 208c48.3 0 92.7-16.4 128-44v16.3c0 6.4 2.5 12.5 7 17l99.7 99.7c9.4 9.4 24.6 9.4 33.9 0l28.3-28.3c9.4-9.4 9.4-24.6.1-34zM208 336c-70.7 0-128-57.2-128-128 0-70.7 57.2-128 128-128 70.7 0 128 57.2 128 128 0 70.7-57.2 128-128 128z">
</path>
</svg>
<span id="site-search-button-1009961" class="hidden-xs hidden-sm ">Search</span>
</button>
</span>
</div>
<div class="clearfix"></div>
</form>POST https://www.telegraphherald.com/users/logout/
<form method="post" action="https://www.telegraphherald.com/users/logout/" id="user-logout-form-1009962"><input type="hidden" name="referer_url"
value="https://www.telegraphherald.com/news/tri-state/article_cc48af36-ab4b-11ee-93fb-b78c101851bb.html"><input type="submit" name="logout" value="Logout" class="hide">
</form>GET /search/
<form action="/search/" method="GET" class="yamm-content">
<input type="hidden" name="l" value="25">
<input type="hidden" name="sd" value="desc">
<input type="hidden" name="s" value="start_time">
<input type="hidden" name="f" value="html">
<input type="hidden" name="t" value="article,video,youtube,collection">
<div class="input-group">
<input name="q" type="text" placeholder="Search..." title="Site Search" class="form-control" autocomplete="off">
<input type="submit" class="hide" value="Search">
<span class="input-group-btn">
<button class="btn btn-default site-search-btn" type="submit"> Search </button>
</span>
</div>
<div class="clearfix"></div>
</form>POST https://www.telegraphherald.com/users/logout/
<form method="post" action="https://www.telegraphherald.com/users/logout/" id="user-logout-form-1009955"><input type="hidden" name="referer_url"
value="https://www.telegraphherald.com/news/tri-state/article_cc48af36-ab4b-11ee-93fb-b78c101851bb.html"><input type="submit" name="logout" value="Logout" class="hide">
</form>GET /search/
<form id="site-search-1009954" aria-label="Site search" action="/search/" method="GET">
<input type="hidden" name="l" value="25">
<input type="hidden" name="s" value="start_time">
<input type="hidden" name="sd" value="desc">
<input type="hidden" name="f" value="html">
<input type="hidden" name="t" value="article,video,youtube,collection">
<input type="hidden" name="app" value="editorial">
<input type="hidden" name="nsa" value="eedition">
<div id="site-search-form-1009954" class="site-search-form input-group pull-right normal ">
<label for="site-search-1009954-term" class="sr-only">Site search</label>
<input id="site-search-1009954-term" name="q" title="Site search" type="text" placeholder="Search..." class="form-control" autocomplete="off">
<input type="submit" class="hide" value="Search">
<span class="input-group-btn">
<button id="site-search-1009954-btn" class="btn btn-primary" aria-label="Submit Site Search" type="submit">
<svg class="tnt-svg tnt-search tnt-w-16 hidden-xl hidden-lg hidden-md" aria-hidden="true" data-prefix="fas" data-icon="search" role="presentation" xmlns="https://www.w3.org/2000/svg" viewBox="0 0 512 512" data-fa-i2svg="">
<path fill="currentColor"
d="M505 442.7L405.3 343c-4.5-4.5-10.6-7-17-7H372c27.6-35.3 44-79.7 44-128C416 93.1 322.9 0 208 0S0 93.1 0 208s93.1 208 208 208c48.3 0 92.7-16.4 128-44v16.3c0 6.4 2.5 12.5 7 17l99.7 99.7c9.4 9.4 24.6 9.4 33.9 0l28.3-28.3c9.4-9.4 9.4-24.6.1-34zM208 336c-70.7 0-128-57.2-128-128 0-70.7 57.2-128 128-128 70.7 0 128 57.2 128 128 0 70.7-57.2 128-128 128z">
</path>
</svg>
<span id="site-search-button-1009954" class="hidden-xs hidden-sm ">Search</span>
</button>
</span>
</div>
<div class="clearfix"></div>
</form>POST /users/admin/list/
<form method="post" data-uuid="cc48af36-ab4b-11ee-93fb-b78c101851bb" class="save-list-cc48af36-ab4b-11ee-93fb-b78c101851bb-form save-asset-to-list" action="/users/admin/list/">
<input type="hidden" name="action" value="addasset">
<input type="hidden" name="format" value="json">
<input type="hidden" name="listasset" value="cc48af36-ab4b-11ee-93fb-b78c101851bb">
<input type="hidden" name="listapp" value="editorial">
<input type="hidden" name="autocreate" value="true">
<input type="hidden" name="listname" value="articles">
<input class="hide" type="submit" name="submit" value="Save">
</form>POST /users/admin/list/
<form method="post" data-uuid="aace2101-15e8-580d-a470-9b5a7daf1027" class="save-list-aace2101-15e8-580d-a470-9b5a7daf1027-form save-asset-to-list" action="/users/admin/list/">
<input type="hidden" name="action" value="addasset">
<input type="hidden" name="format" value="json">
<input type="hidden" name="listasset" value="aace2101-15e8-580d-a470-9b5a7daf1027">
<input type="hidden" name="listapp" value="editorial">
<input type="hidden" name="autocreate" value="true">
<input type="hidden" name="listname" value="images">
<input class="hide" type="submit" name="submit" value="Save">
</form>POST /users/admin/list/
<form method="post" data-uuid="cc48af36-ab4b-11ee-93fb-b78c101851bb" class="save-list-cc48af36-ab4b-11ee-93fb-b78c101851bb-form save-asset-to-list" action="/users/admin/list/">
<input type="hidden" name="action" value="addasset">
<input type="hidden" name="format" value="json">
<input type="hidden" name="listasset" value="cc48af36-ab4b-11ee-93fb-b78c101851bb">
<input type="hidden" name="listapp" value="editorial">
<input type="hidden" name="autocreate" value="true">
<input type="hidden" name="listname" value="articles">
<input class="hide" type="submit" name="submit" value="Save">
</form>POST /users/admin/list/
<form method="post" data-uuid="cc48af36-ab4b-11ee-93fb-b78c101851bb" class="save-list-cc48af36-ab4b-11ee-93fb-b78c101851bb-form save-asset-to-list" action="/users/admin/list/">
<input type="hidden" name="action" value="addasset">
<input type="hidden" name="format" value="json">
<input type="hidden" name="listasset" value="cc48af36-ab4b-11ee-93fb-b78c101851bb">
<input type="hidden" name="listapp" value="editorial">
<input type="hidden" name="autocreate" value="true">
<input type="hidden" name="listname" value="articles">
<input class="hide" type="submit" name="submit" value="Save">
</form>POST /users/admin/list/
<form method="post" data-uuid="cc48af36-ab4b-11ee-93fb-b78c101851bb" class="save-list-cc48af36-ab4b-11ee-93fb-b78c101851bb-form save-asset-to-list" action="/users/admin/list/">
<input type="hidden" name="action" value="addasset">
<input type="hidden" name="format" value="json">
<input type="hidden" name="listasset" value="cc48af36-ab4b-11ee-93fb-b78c101851bb">
<input type="hidden" name="listapp" value="editorial">
<input type="hidden" name="autocreate" value="true">
<input type="hidden" name="listname" value="articles">
<input class="hide" type="submit" name="submit" value="Save">
</form>POST {{action}}
<form id="follow-notify-form" class="follow-notify-form" action="{{action}}" method="post">
<input class="input-notification-name" type="hidden" name="title" value="{{title}}">
<div class="row">
<div class="col-sm-6">
<button class="btn btn-success btn-block follow-btn" data-tncms-track-dmp="is_followed_notifications_user">
<i class="fas tnt-spinner tnt-pulse" style="display:none;"></i> Save </button>
</div>
<div class="col-sm-6">
<a class="btn btn-default btn-block" href="https://www.telegraphherald.com/users/admin/savedsearch/">Manage followed notifications</a>
</div>
</div>
</form>POST /tncms/auth/begin/?provider=Newzware&return=https%3A%2F%2Fwww.telegraphherald.com%2Fnews%2Ftri-state%2Farticle_cc48af36-ab4b-11ee-93fb-b78c101851bb.html
<form id="user-register-form" class="user-login-form" role="form" method="post" action="/tncms/auth/begin/?provider=Newzware&return=https%3A%2F%2Fwww.telegraphherald.com%2Fnews%2Ftri-state%2Farticle_cc48af36-ab4b-11ee-93fb-b78c101851bb.html"
novalidate="novalidate"><input name="referer_url" type="hidden" value="/">
<fieldset>
<legend class="sr-only">User information</legend>
<div class="form-group">
<label for="input-username" class="control-label hide"> Username (Optional) </label>
<div class="input-container">
<input id="input-username" class="form-control" type="text" name="screen_name" value="" data-check-url="https://www.telegraphherald.com/users/check/" placeholder="Username (Optional)" data-toggle="tooltip" data-placement="top" title=""
data-original-title=" This is the name that will be displayed next to your photo for comments, blog posts, and more. Choose wisely!">
<span class="sr-only"> This is the name that will be displayed next to your photo for comments, blog posts, and more. Choose wisely!</span>
</div>
</div>
<div class="form-group">
<label for="input-email" class="control-label hide"><span class="text-danger">*</span> Email Address</label>
<div class="input-container">
<input id="input-email" class="form-control" type="email" name="email" value="" placeholder="Email Address" data-toggle="tooltip" data-placement="top" title="" required=""
data-original-title="Your email address will be used to confirm your account. We won't share it with anyone else." aria-required="true">
<span class="sr-only">Your email address will be used to confirm your account. We won't share it with anyone else.</span>
</div>
</div>
<div class="form-group">
<label for="input-password" class="control-label hide"><span class="text-danger">*</span> Password</label>
<div class="input-container">
<input id="input-password" class="form-control" type="password" name="password" autocomplete="off" placeholder="Password" data-toggle="tooltip" data-placement="top" title="" required=""
data-original-title="Create a password that only you will remember. If you forget it, you'll be able to recover it using your email address." aria-required="true">
<span class="sr-only">Create a password that only you will remember. If you forget it, you'll be able to recover it using your email address.</span>
</div>
</div>
<div class="form-group">
<label for="input-confirm-password" class="control-label hide"><span class="text-danger">*</span> Confirm Password</label>
<div class="input-container">
<input id="input-confirm-password" class="form-control" type="password" name="password_verify" autocomplete="off" placeholder="Confirm Password" data-toggle="tooltip" data-placement="top" title="" required=""
data-original-title="Confirm your password." aria-required="true">
<span class="sr-only">Confirm your password.</span>
</div>
</div>
</fieldset>
<div class="form-group">
<label for="tncms_captcha_response" class="sr-only">CAPTCHA</label>
<div class="input-container text-center">
<div id="tn-vk-modal-signup" class="tn-vk-container" data-subscription-recaptcha=""></div>
</div>
</div>
<div class="user-register-submit form-group">
<div class="input-container text-center">
<button type="submit" class="btn btn-lg btn-primary">Create Account</button>
</div>
</div>
</form>POST https://www.telegraphherald.com/users/login/
<form role="form" method="post" action="https://www.telegraphherald.com/users/login/" class=""><input type="hidden" name="referer_url" value="https://www.telegraphherald.com/news/tri-state/article_cc48af36-ab4b-11ee-93fb-b78c101851bb.html"><button
type="submit" name="username" value="provider:Newzware" class="btn btn-block btn-lg btn-Newzware">
<svg class="tnt-svg tnt-circle tnt-w-16 tnt-fw" aria-hidden="true" data-prefix="far" data-icon="circle" role="presentation" xmlns="https://www.w3.org/2000/svg" viewBox="0 0 512 512" data-fa-i2svg="">
<path fill="currentColor" d="M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8zm0 448c-110.5 0-200-89.5-200-200S145.5 56 256 56s200 89.5 200 200-89.5 200-200 200z"></path>
</svg> Newzware</button></form>POST https://www.telegraphherald.com/users/login/
<form id="access-modal-login-form" class="user-login-form" role="form" method="post" action="https://www.telegraphherald.com/users/login/">
<div class="alert alert-danger critical-error hide">
<p>Invalid password or account does not exist</p>
</div><input type="hidden" name="referer_url" value="https%3A%2F%2Fwww.telegraphherald.com%2Fnews%2Ftri-state%2Farticle_cc48af36-ab4b-11ee-93fb-b78c101851bb.html">
<div class="user-login-username form-group">
<label for="user-username" class="control-label hide">Email Address</label>
<div class="input-container">
<input id="user-username" class="form-control" name="username" type="text" value="" placeholder="Email Address" required="">
</div>
</div>
<div class="user-login-password form-group">
<label for="user-password" class="control-label hide">Password</label>
<div class="input-group">
<input id="user-password" class="form-control" name="password" type="password" autocomplete="off" required="" placeholder="Password">
<div id="user-password-toggle" class="input-group-addon password-toggle" title="Toggle password visibility">
<svg class="tnt-svg tnt-eye tnt-w-18" aria-hidden="true" data-prefix="fas" data-icon="eye" role="presentation" xmlns="https://www.w3.org/2000/svg" viewBox="0 0 576 512" data-fa-i2svg="">
<path fill="currentColor"
d="M572.52 241.4C518.29 135.59 410.93 64 288 64S57.68 135.64 3.48 241.41a32.35 32.35 0 0 0 0 29.19C57.71 376.41 165.07 448 288 448s230.32-71.64 284.52-177.41a32.35 32.35 0 0 0 0-29.19zM288 400a144 144 0 1 1 144-144 143.93 143.93 0 0 1-144 144zm0-240a95.31 95.31 0 0 0-25.31 3.79 47.85 47.85 0 0 1-66.9 66.9A95.78 95.78 0 1 0 288 160z">
</path>
</svg>
</div>
</div>
</div>
<div class="user-login-remember form-group row">
<div class="input-container col-xs-6">
</div>
<div class="col-xs-6 text-right forgot-wrapper">
<a id="open-modal-forgot" class="" rel="nofollow" href="https://www.telegraphherald.com/users/forgot/?referer_url=https%253A%252F%252Fwww.telegraphherald.com%252Fnews%252Ftri-state%252Farticle_cc48af36-ab4b-11ee-93fb-b78c101851bb.html">
Forgot your password?
</a>
</div>
</div>
<div class="user-login-submit form-group">
<div class="input-container text-center">
<button type="submit" class="btn btn-lg btn-primary">Log In</button>
</div>
</div>
<div class="text-center form-group">
<a id="open-modal-instant-login" class="btn btn-sm btn-default btn-instant-login" rel="nofollow" href="https://www.telegraphherald.com/users/instant-login/?referer_url=https%253A%252F%252Fwww.telegraphherald.com%252Fnews%252Ftri-state%252Farticle_cc48af36-ab4b-11ee-93fb-b78c101851bb.html">
Email me a log in link
</a>
</div>
</form>POST https://www.telegraphherald.com/users/login/
<form role="form" method="post" action="https://www.telegraphherald.com/users/login/" class=""><input type="hidden" name="referer_url" value="https://www.telegraphherald.com/news/tri-state/article_cc48af36-ab4b-11ee-93fb-b78c101851bb.html"><button
type="submit" name="username" value="provider:Newzware" class="btn btn-block btn-lg btn-Newzware">
<svg class="tnt-svg tnt-circle tnt-w-16 tnt-fw" aria-hidden="true" data-prefix="far" data-icon="circle" role="presentation" xmlns="https://www.w3.org/2000/svg" viewBox="0 0 512 512" data-fa-i2svg="">
<path fill="currentColor" d="M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8zm0 448c-110.5 0-200-89.5-200-200S145.5 56 256 56s200 89.5 200 200-89.5 200-200 200z"></path>
</svg> Newzware</button></form>POST https://www.telegraphherald.com/users/forgot/
<form id="user-modal-forgot-form" role="form" method="post" action="https://www.telegraphherald.com/users/forgot/">
<input type="hidden" name="referer_url" value="https%3A%2F%2Fwww.telegraphherald.com%2Fnews%2Ftri-state%2Farticle_cc48af36-ab4b-11ee-93fb-b78c101851bb.html">
<div class="user-login-username form-group">
<label for="forgot-username" class="sr-only">Email or Screen Name</label>
<input id="forgot-username" class="form-control" name="username" type="text" placeholder="Email or Screen Name" value="" required="">
</div>
<div class="form-group">
<label for="g-recaptcha-response-1" class="sr-only">CAPTCHA</label>
<div class="input-container text-center">
<div id="tn-vk-modal-forgot" class="tn-vk-container" data-subscription-recaptcha=""></div>
</div>
</div>
<div class="user-login-submit form-group">
<div class="text-center">
<button type="submit" class="btn btn-primary">Reset Password</button>
</div>
</div>
</form>POST https://www.telegraphherald.com/users/instant-login/
<form id="instant-login-form" class="form-horizontal" role="form" method="post" action="https://www.telegraphherald.com/users/instant-login/">
<div class="form-group">
<div class="col-xs-12">
<label for="instant-login-email" class="sr-only">Account Email</label>
<input id="instant-login-email" class="form-control" name="email" type="email" value="" required="" placeholder="Account Email">
</div>
</div>
<div class="form-group">
<label for="tncms_captcha_response" class="sr-only">CAPTCHA</label>
<div class="input-container text-center">
<div id="tn-vk-modal-instant-login" class="tn-vk-container" data-subscription-recaptcha=""></div>
</div>
</div>
<div class="user-login-link-submit form-group">
<div class="text-center">
<button type="submit" class="btn btn-primary">Send Email</button>
</div>
</div>
</form>POST https://www.telegraphherald.com/tncms/subscription/services/
<form id="service-promo-fetch" class="text-left service-promo-open form-horizontal" role="form" method="post" action="https://www.telegraphherald.com/tncms/subscription/services/">
<input type="hidden" name="serviceid" value="">
<div class="form-group">
<label for="promo" class="sr-only">Enter Promo Code</label>
</div>
<div class="form-group">
<div class="input-group col-sm-8 col-sm-push-2">
<input type="text" class="form-control" name="promoCode" placeholder="Enter Promo Code" value="">
<span class="input-group-btn">
<button type="submit" class="btn btn-primary">Redeem</button>
</span>
</div>
</div>
</form><form id="form-federated-auth-super-purchase-email" class="form-horizontal" onsubmit="selectedContinueWithEmailSpreedly(); return false">
<fieldset class="col-xs-12">
<legend>Sign in with</legend>
<div class="form-group">
<label for="email-federated-option-super-purchase" class="control-label sr-only"> Email Address </label>
<input id="email-federated-option-super-purchase" type="email" name="email" class="form-control" placeholder="Email Address" data-required="" required="">
</div>
<div class="form-group">
<button value="blox-account" class="btn btn-block btn-lg btn-local-account" id="form-federated-auth-super-purchase-blox-account">
<span class=""></span> Continue with Email Address </button>
</div>
</fieldset>
</form>POST https://www.telegraphherald.com/users/login/
<form role="form" method="post" action="https://www.telegraphherald.com/users/login/" class="form-horizontal not-logged-in" style="display: block;"><input type="hidden" name="referer_url"
value="https://www.telegraphherald.com/news/tri-state/article_cc48af36-ab4b-11ee-93fb-b78c101851bb.html"><button type="submit" name="username" value="provider:Newzware" class="btn btn-block btn-lg btn-Newzware">
<svg class="tnt-svg tnt-circle tnt-w-16 tnt-fw" aria-hidden="true" data-prefix="far" data-icon="circle" role="presentation" xmlns="https://www.w3.org/2000/svg" viewBox="0 0 512 512" data-fa-i2svg="">
<path fill="currentColor" d="M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8zm0 448c-110.5 0-200-89.5-200-200S145.5 56 256 56s200 89.5 200 200-89.5 200-200 200z"></path>
</svg> Continue with Newzware</button></form>POST /tncms/subscription/buy_paypal/
<form id="tncms-paypal-super-purchase" action="/tncms/subscription/buy_paypal/" method="post" class="hide">
<input name="referrer_url" type="hidden" value="https://www.telegraphherald.com/news/tri-state/article_cc48af36-ab4b-11ee-93fb-b78c101851bb.html">
<input name="service_id" type="hidden" value="">
<input name="rate_id" type="hidden" value="">
<input name="email" type="hidden" value="">
<input name="password" type="password" value="">
<input name="password_verify" type="password" value="">
<input name="postal-postcode" type="hidden" value="">
<input name="postal-country" type="hidden" value="">
<input name="postal_code" type="hidden" value="">
<input name="country" type="hidden" value="">
</form>POST /tncms/subscription/buy/
<form id="form-super-purchase" class="form-horizontal spreedly-initialized not-logged-in-form-disabled" role="form" action="/tncms/subscription/buy/" method="post" data-taxable="false" onsubmit="submitPaymentFormSpreedly(); return false"
data-auth-federated="true" novalidate="novalidate" hidden="">
<input type="hidden" name="referrer_url" value="https://www.telegraphherald.com/news/tri-state/article_cc48af36-ab4b-11ee-93fb-b78c101851bb.html">
<input type="hidden" name="service_id" value="">
<input type="hidden" name="rate_name" value="">
<input type="hidden" name="rate_id" value="">
<input type="hidden" name="rate_price" value="">
<input type="hidden" name="tnpay-token" id="tnpay-token-super-purchase"><input type="hidden" id="voight-kampf-super-purchase" name="recaptcha_token" value=""><input type="hidden" name="promoCode" value="">
<div class="logged-in alert alert-success row purchase-standard" role="alert" style="display: none;">
<div class="col-sm-8 text-left">You are logged in <strong class="tn-user-screenname"></strong></div>
<div class="col-sm-4 text-right">
<a class="alert-link" href="https://www.telegraphherald.com/users/login/?referer_url=https%3A%2F%2Fwww.telegraphherald.com%2Fnews%2Ftri-state%2Farticle_cc48af36-ab4b-11ee-93fb-b78c101851bb.html">Switch accounts</a></div>
</div>
<fieldset id="form-signup-super-purchase" class="col-xs-12 not-logged-in purchase-standard hide" style="display: block;">
<legend>What's your email address?</legend>
<div class="form-group">
<label for="email-super-purchase" class="control-label sr-only">Email</label>
<input id="email-super-purchase" type="email" name="email" class="form-control" placeholder="Email" data-required="" data-required-logged-out="" required="" aria-required="true">
</div>
<div class="form-group">
<div class="row">
<div class="col-xs-6">
<label for="password-super-purchase" class="sr-only">Password</label>
<input id="password-super-purchase" type="password" name="password" class="form-control" placeholder="Password" data-required="" data-required-logged-out="" required="" aria-required="true">
</div>
<div class="col-xs-6">
<label for="password-verify-super-purchase" class="sr-only">Confirm password</label>
<input id="password-verify-super-purchase" type="password" name="password_verify" class="form-control" placeholder="Confirm password">
</div>
</div>
</div>
</fieldset>
<fieldset id="form-gift-to-super-purchase" class="col-xs-12 purchase-gift">
<legend>Who is this gift for?</legend>
<div class="form-group">
<div class="row">
<div class="col-xs-12 col-md-6">
<label for="field-recipient-name-super-purchase" class="control-label sr-only">Recipient name</label>
<input id="field-recipient-name-super-purchase" class="form-control" type="text" name="recipient_name" placeholder="Recipient name" data-required="" required="" aria-required="true">
</div>
<div class="col-xs-12 col-md-6">
<label for="field-recipient-email-super-purchase" class="control-label sr-only">Recipient email</label>
<input id="field-recipient-email-super-purchase" class="form-control" type="email" name="recipient_email" placeholder="Recipient email" data-required="" required="" aria-required="true">
</div>
</div>
</div>
<div class="form-group">
<div class="row">
<div id="gift-message" class="col-xs-12">
<label for="field-gift-message-super-purchase" class="control-label sr-only">Optional message for the recipient</label>
<textarea id="field-gift-message-super-purchase" class="form-control" name="message" rows="4" placeholder="Optional message for the recipient"></textarea>
</div>
</div>
</div>
</fieldset>
<fieldset id="form-gift-from-super-purchase" class="col-xs-12 purchase-gift">
<legend>Who is this gift from?</legend>
<div id="purchaser-info" class="form-group-flex">
<div id="purchaser-name">
<label for="field-purchaser-name-super-purchase" class="control-label sr-only">Purchaser name</label>
<input id="field-purchaser-name-super-purchase" class="form-control" type="text" name="purchaser_name" placeholder="Purchaser name" data-required="" required="" aria-required="true">
</div>
<div id="purchaser-email">
<label for="field-purchaser-email-super-purchase" class="control-label sr-only">Purchaser email</label>
<input id="field-purchaser-email-super-purchase" class="form-control" type="email" name="purchaser_email" placeholder="Purchaser email" data-required="" required="" aria-required="true">
</div>
</div><template id="purchaser-zip-template">
<div id="purchaser-zip">
<label for="field-purchaser-zip-super-purchase" class="control-label sr-only">Purchaser zip code</label>
<input id="field-purchaser-zip-super-purchase" class="form-control" type="text" name="purchaser_zip" placeholder="Purchaser zip code" data-required="" required="">
</div>
</template>
</fieldset>
<fieldset id="form-gift-deliver-super-purchase" class="col-xs-12 purchase-gift">
<legend>Delivery date</legend>
<div class="form-group">
<div class="row">
<div class="col-xs-12">
<label for="field-gift-date-super-purchase" class="control-label sr-only">Delivery date</label>
</div>
<div class="col-xs-12">
<input id="field-gift-date-super-purchase" class="form-control" name="delivery_date" type="date" value="2024-01-05">
</div>
</div>
</div>
</fieldset>
<fieldset id="form-billing-location-super-purchase" class="col-xs-12 tnt-tax-detail">
<legend> What's your billing location? </legend>
<div class="form-group-flex">
<div id="billing-state">
<label for="field-postal-state-super-purchase" class="control-label sr-only"> State </label>
<select id="field-postal-state-super-purchase" class="form-control" name="postal-state" placeholder="State">
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA" selected="">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="DC">Washington D.C.</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
<option value="PR">Puerto Rico</option>
<option value="VI">US Virgin Islands</option>
<option value="AA">Armed Forces Americas</option>
<option value="AP">Armed Forces Pacific</option>
<option value="AE">Armed Forces Europe</option>
<option value="MP">Northern Mariana Islands</option>
<option value="MH">Marshall Islands</option>
<option value="AS">American Samoa</option>
<option value="FM">Federated States of Micronesia</option>
<option value="GU">Guam</option>
<option value="PW">Palau</option>
<option value="AB">Alberta, Canada</option>
<option value="BC">British Columbia, Canada</option>
<option value="MB">Manitoba, Canada</option>
<option value="NB">New Brunswick, Canada</option>
<option value="NL">Newfoundland, Canada</option>
<option value="NS">Nova Scotia, Canada</option>
<option value="NT">Northwest Territories, Canada</option>
<option value="NU">Nunavut, Canada</option>
<option value="ON">Ontario, Canada</option>
<option value="PE">Prince Edward Island, Canada</option>
<option value="QC">Quebec, Canada</option>
<option value="SK">Saskatchewan, Canada</option>
<option value="YT">Yukon Territory, Canada</option>
</select>
</div>
<div id="billing-postcode">
<label for="field-postal-postcode-super-purchase" class="control-label sr-only"> Zip Code </label>
<input id="field-postal-postcode-super-purchase" type="text" name="postal-postcode" maxlength="6" class="form-control" placeholder="Zip code" required="" aria-required="true">
</div>
<div id="billing-country">
<label for="field-postal-country-super-purchase" class="control-label sr-only"> Country </label>
<select id="field-postal-country-super-purchase" name="postal-country" class="form-control">
<option value="US" selected="">United States of America</option>
<option value="VI">US Virgin Islands</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="CA">Canada</option>
<option value="MX">Mexico, United Mexican States</option>
<option value="BS">Bahamas, Commonwealth of the</option>
<option value="CU">Cuba, Republic of</option>
<option value="DO">Dominican Republic</option>
<option value="HT">Haiti, Republic of</option>
<option value="JM">Jamaica</option>
<option value="AF">Afghanistan</option>
<option value="AL">Albania, People's Socialist Republic of</option>
<option value="DZ">Algeria, People's Democratic Republic of</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra, Principality of</option>
<option value="AO">Angola, Republic of</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica (the territory South of 60 deg S)</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina, Argentine Republic</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia, Commonwealth of</option>
<option value="AT">Austria, Republic of</option>
<option value="AZ">Azerbaijan, Republic of</option>
<option value="BH">Bahrain, Kingdom of</option>
<option value="BD">Bangladesh, People's Republic of</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium, Kingdom of</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin, People's Republic of</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan, Kingdom of</option>
<option value="BO">Bolivia, Republic of</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana, Republic of</option>
<option value="BV">Bouvet Island (Bouvetoya)</option>
<option value="BR">Brazil, Federative Republic of</option>
<option value="IO">British Indian Ocean Territory (Chagos Archipelago)</option>
<option value="VG">British Virgin Islands</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria, People's Republic of</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi, Republic of</option>
<option value="KH">Cambodia, Kingdom of</option>
<option value="CM">Cameroon, United Republic of</option>
<option value="CV">Cape Verde, Republic of</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad, Republic of</option>
<option value="CL">Chile, Republic of</option>
<option value="CN">China, People's Republic of</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia, Republic of</option>
<option value="KM">Comoros, Union of the</option>
<option value="CD">Congo, Democratic Republic of</option>
<option value="CG">Congo, People's Republic of</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica, Republic of</option>
<option value="CI">Cote D'Ivoire, Ivory Coast, Republic of the</option>
<option value="CY">Cyprus, Republic of</option>
<option value="CZ">Czech Republic</option>
<option value="DK">Denmark, Kingdom of</option>
<option value="DJ">Djibouti, Republic of</option>
<option value="DM">Dominica, Commonwealth of</option>
<option value="EC">Ecuador, Republic of</option>
<option value="EG">Egypt, Arab Republic of</option>
<option value="SV">El Salvador, Republic of</option>
<option value="GQ">Equatorial Guinea, Republic of</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="FO">Faeroe Islands</option>
<option value="FK">Falkland Islands (Malvinas)</option>
<option value="FJ">Fiji, Republic of the Fiji Islands</option>
<option value="FI">Finland, Republic of</option>
<option value="FR">France, French Republic</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon, Gabonese Republic</option>
<option value="GM">Gambia, Republic of the</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana, Republic of</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece, Hellenic Republic</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadaloupe</option>
<option value="GU">Guam</option>
<option value="GT">Guatemala, Republic of</option>
<option value="GN">Guinea, Revolutionary People's Rep'c of</option>
<option value="GW">Guinea-Bissau, Republic of</option>
<option value="GY">Guyana, Republic of</option>
<option value="HM">Heard and McDonald Islands</option>
<option value="VA">Holy See (Vatican City State)</option>
<option value="HN">Honduras, Republic of</option>
<option value="HK">Hong Kong, Special Administrative Region of China</option>
<option value="HR">Hrvatska (Croatia)</option>
<option value="HU">Hungary, Hungarian People's Republic</option>
<option value="IS">Iceland, Republic of</option>
<option value="IN">India, Republic of</option>
<option value="ID">Indonesia, Republic of</option>
<option value="IR">Iran, Islamic Republic of</option>
<option value="IQ">Iraq, Republic of</option>
<option value="IE">Ireland</option>
<option value="IL">Israel, State of</option>
<option value="IT">Italy, Italian Republic</option>
<option value="JP">Japan</option>
<option value="JO">Jordan, Hashemite Kingdom of</option>
<option value="KZ">Kazakhstan, Republic of</option>
<option value="KE">Kenya, Republic of</option>
<option value="KI">Kiribati, Republic of</option>
<option value="KP">Korea, Democratic People's Republic of</option>
<option value="KR">Korea, Republic of</option>
<option value="KW">Kuwait, State of</option>
<option value="KG">Kyrgyz Republic</option>
<option value="LA">Lao People's Democratic Republic</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon, Lebanese Republic</option>
<option value="LS">Lesotho, Kingdom of</option>
<option value="LR">Liberia, Republic of</option>
<option value="LY">Libyan Arab Jamahiriya</option>
<option value="LI">Liechtenstein, Principality of</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg, Grand Duchy of</option>
<option value="MO">Macao, Special Administrative Region of China</option>
<option value="MK">Macedonia, the former Yugoslav Republic of</option>
<option value="MG">Madagascar, Republic of</option>
<option value="MW">Malawi, Republic of</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives, Republic of</option>
<option value="ML">Mali, Republic of</option>
<option value="MT">Malta, Republic of</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania, Islamic Republic of</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="FM">Micronesia, Federated States of</option>
<option value="MD">Moldova, Republic of</option>
<option value="MC">Monaco, Principality of</option>
<option value="MN">Mongolia, Mongolian People's Republic</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco, Kingdom of</option>
<option value="MZ">Mozambique, People's Republic of</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru, Republic of</option>
<option value="NP">Nepal, Kingdom of</option>
<option value="AN">Netherlands Antilles</option>
<option value="NL">Netherlands, Kingdom of the</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua, Republic of</option>
<option value="NE">Niger, Republic of the</option>
<option value="NG">Nigeria, Federal Republic of</option>
<option value="NU">Niue, Republic of</option>
<option value="NF">Norfolk Island</option>
<option value="MP">Northern Mariana Islands</option>
<option value="NO">Norway, Kingdom of</option>
<option value="OM">Oman, Sultanate of</option>
<option value="PK">Pakistan, Islamic Republic of</option>
<option value="PW">Palau</option>
<option value="PS">Palestinian Territory, Occupied</option>
<option value="PA">Panama, Republic of</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay, Republic of</option>
<option value="PE">Peru, Republic of</option>
<option value="PH">Philippines, Republic of the</option>
<option value="PN">Pitcairn Island</option>
<option value="PL">Poland, Polish People's Republic</option>
<option value="PT">Portugal, Portuguese Republic</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar, State of</option>
<option value="RE">Reunion</option>
<option value="RO">Romania, Socialist Republic of</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda, Rwandese Republic</option>
<option value="WS">Samoa, Independent State of</option>
<option value="SM">San Marino, Republic of</option>
<option value="ST">Sao Tome and Principe, Democratic Republic of</option>
<option value="SA">Saudi Arabia, Kingdom of</option>
<option value="SN">Senegal, Republic of</option>
<option value="CS">Serbia and Montenegro</option>
<option value="SC">Seychelles, Republic of</option>
<option value="SL">Sierra Leone, Republic of</option>
<option value="SG">Singapore, Republic of</option>
<option value="SK">Slovakia (Slovak Republic)</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia, Somali Republic</option>
<option value="ZA">South Africa, Republic of</option>
<option value="GS">South Georgia and the South Sandwich Islands</option>
<option value="ES">Spain, Spanish State</option>
<option value="LK">Sri Lanka, Democratic Socialist Republic of</option>
<option value="SH">St. Helena</option>
<option value="KN">St. Kitts and Nevis</option>
<option value="LC">St. Lucia</option>
<option value="PM">St. Pierre and Miquelon</option>
<option value="VC">St. Vincent and the Grenadines</option>
<option value="SD">Sudan, Democratic Republic of the</option>
<option value="SR">Suriname, Republic of</option>
<option value="SJ">Svalbard & Jan Mayen Islands</option>
<option value="SZ">Swaziland, Kingdom of</option>
<option value="SE">Sweden, Kingdom of</option>
<option value="CH">Switzerland, Swiss Confederation</option>
<option value="SY">Syrian Arab Republic</option>
<option value="TW">Taiwan, Province of China</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania, United Republic of</option>
<option value="TH">Thailand, Kingdom of</option>
<option value="TL">Timor-Leste, Democratic Republic of</option>
<option value="TG">Togo, Togolese Republic</option>
<option value="TK">Tokelau (Tokelau Islands)</option>
<option value="TO">Tonga, Kingdom of</option>
<option value="TT">Trinidad and Tobago, Republic of</option>
<option value="TN">Tunisia, Republic of</option>
<option value="TR">Turkey, Republic of</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda, Republic of</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom of Great Britain & N. Ireland</option>
<option value="UY">Uruguay, Eastern Republic of</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VE">Venezuela, Bolivarian Republic of</option>
<option value="VN">Viet Nam, Socialist Republic of</option>
<option value="WF">Wallis and Futuna Islands</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia, Republic of</option>
<option value="ZW">Zimbabwe</option>
</select>
</div>
</div>
</fieldset>
<fieldset id="form-location-super-purchase" class="col-xs-12 delivery-location-required" hidden="">
<legend>What's your delivery address?</legend>
<div class="form-group tnt-tax-detail">
<label>
<input id="same-info-super-purchase" class="same-info" type="checkbox" name="same_info">
<b style="position:relative;top:-2px;padding-left:10px;">Copy billing location</b>
</label>
</div>
<div class="form-group">
<label for="address-super-purchase" class="control-label sr-only">Address</label>
<input id="address-super-purchase" type="text" name="address" class="form-control" placeholder="Address">
</div>
<div class="form-group">
<label for="municipality-super-purchase" class="control-label sr-only">City</label>
<input id="municipality-super-purchase" type="text" name="municipality" class="form-control" placeholder="City">
</div>
<div class="form-group">
<div class="row">
<div class="col-xs-7 col-md-4">
<label for="region-super-purchase" class="control-label sr-only">State</label>
<select id="region-super-purchase" class="form-control" name="region" placeholder="State">
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA" selected="">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="DC">Washington D.C.</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
<option value="PR">Puerto Rico</option>
<option value="VI">US Virgin Islands</option>
<option value="AA">Armed Forces Americas</option>
<option value="AP">Armed Forces Pacific</option>
<option value="AE">Armed Forces Europe</option>
<option value="MP">Northern Mariana Islands</option>
<option value="MH">Marshall Islands</option>
<option value="AS">American Samoa</option>
<option value="FM">Federated States of Micronesia</option>
<option value="GU">Guam</option>
<option value="PW">Palau</option>
<option value="AB">Alberta, Canada</option>
<option value="BC">British Columbia, Canada</option>
<option value="MB">Manitoba, Canada</option>
<option value="NB">New Brunswick, Canada</option>
<option value="NL">Newfoundland, Canada</option>
<option value="NS">Nova Scotia, Canada</option>
<option value="NT">Northwest Territories, Canada</option>
<option value="NU">Nunavut, Canada</option>
<option value="ON">Ontario, Canada</option>
<option value="PE">Prince Edward Island, Canada</option>
<option value="QC">Quebec, Canada</option>
<option value="SK">Saskatchewan, Canada</option>
<option value="YT">Yukon Territory, Canada</option>
</select>
</div>
<div class="col-xs-5 col-md-3">
<label for="postal-code-super-purchase" class="control-label sr-only">Zip code</label>
<input id="postal-code-super-purchase" type="text" name="postal_code" maxlength="6" class="form-control" placeholder="Zip code">
</div>
</div>
</div>
<div class="form-group">
<div class="row">
<div class="col-xs-7">
<label for="select-country-super-purchase" class="control-label sr-only">Country</label>
<div class="input-container">
<select id="select-country-super-purchase" name="country" class="form-control">
<option value="US" selected="">United States of America</option>
<option value="VI">US Virgin Islands</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="CA">Canada</option>
<option value="MX">Mexico, United Mexican States</option>
<option value="BS">Bahamas, Commonwealth of the</option>
<option value="CU">Cuba, Republic of</option>
<option value="DO">Dominican Republic</option>
<option value="HT">Haiti, Republic of</option>
<option value="JM">Jamaica</option>
<option value="AF">Afghanistan</option>
<option value="AL">Albania, People's Socialist Republic of</option>
<option value="DZ">Algeria, People's Democratic Republic of</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra, Principality of</option>
<option value="AO">Angola, Republic of</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica (the territory South of 60 deg S)</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina, Argentine Republic</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia, Commonwealth of</option>
<option value="AT">Austria, Republic of</option>
<option value="AZ">Azerbaijan, Republic of</option>
<option value="BH">Bahrain, Kingdom of</option>
<option value="BD">Bangladesh, People's Republic of</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium, Kingdom of</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin, People's Republic of</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan, Kingdom of</option>
<option value="BO">Bolivia, Republic of</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana, Republic of</option>
<option value="BV">Bouvet Island (Bouvetoya)</option>
<option value="BR">Brazil, Federative Republic of</option>
<option value="IO">British Indian Ocean Territory (Chagos Archipelago)</option>
<option value="VG">British Virgin Islands</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria, People's Republic of</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi, Republic of</option>
<option value="KH">Cambodia, Kingdom of</option>
<option value="CM">Cameroon, United Republic of</option>
<option value="CV">Cape Verde, Republic of</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad, Republic of</option>
<option value="CL">Chile, Republic of</option>
<option value="CN">China, People's Republic of</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia, Republic of</option>
<option value="KM">Comoros, Union of the</option>
<option value="CD">Congo, Democratic Republic of</option>
<option value="CG">Congo, People's Republic of</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica, Republic of</option>
<option value="CI">Cote D'Ivoire, Ivory Coast, Republic of the</option>
<option value="CY">Cyprus, Republic of</option>
<option value="CZ">Czech Republic</option>
<option value="DK">Denmark, Kingdom of</option>
<option value="DJ">Djibouti, Republic of</option>
<option value="DM">Dominica, Commonwealth of</option>
<option value="EC">Ecuador, Republic of</option>
<option value="EG">Egypt, Arab Republic of</option>
<option value="SV">El Salvador, Republic of</option>
<option value="GQ">Equatorial Guinea, Republic of</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="FO">Faeroe Islands</option>
<option value="FK">Falkland Islands (Malvinas)</option>
<option value="FJ">Fiji, Republic of the Fiji Islands</option>
<option value="FI">Finland, Republic of</option>
<option value="FR">France, French Republic</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon, Gabonese Republic</option>
<option value="GM">Gambia, Republic of the</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana, Republic of</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece, Hellenic Republic</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadaloupe</option>
<option value="GU">Guam</option>
<option value="GT">Guatemala, Republic of</option>
<option value="GN">Guinea, Revolutionary People's Rep'c of</option>
<option value="GW">Guinea-Bissau, Republic of</option>
<option value="GY">Guyana, Republic of</option>
<option value="HM">Heard and McDonald Islands</option>
<option value="VA">Holy See (Vatican City State)</option>
<option value="HN">Honduras, Republic of</option>
<option value="HK">Hong Kong, Special Administrative Region of China</option>
<option value="HR">Hrvatska (Croatia)</option>
<option value="HU">Hungary, Hungarian People's Republic</option>
<option value="IS">Iceland, Republic of</option>
<option value="IN">India, Republic of</option>
<option value="ID">Indonesia, Republic of</option>
<option value="IR">Iran, Islamic Republic of</option>
<option value="IQ">Iraq, Republic of</option>
<option value="IE">Ireland</option>
<option value="IL">Israel, State of</option>
<option value="IT">Italy, Italian Republic</option>
<option value="JP">Japan</option>
<option value="JO">Jordan, Hashemite Kingdom of</option>
<option value="KZ">Kazakhstan, Republic of</option>
<option value="KE">Kenya, Republic of</option>
<option value="KI">Kiribati, Republic of</option>
<option value="KP">Korea, Democratic People's Republic of</option>
<option value="KR">Korea, Republic of</option>
<option value="KW">Kuwait, State of</option>
<option value="KG">Kyrgyz Republic</option>
<option value="LA">Lao People's Democratic Republic</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon, Lebanese Republic</option>
<option value="LS">Lesotho, Kingdom of</option>
<option value="LR">Liberia, Republic of</option>
<option value="LY">Libyan Arab Jamahiriya</option>
<option value="LI">Liechtenstein, Principality of</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg, Grand Duchy of</option>
<option value="MO">Macao, Special Administrative Region of China</option>
<option value="MK">Macedonia, the former Yugoslav Republic of</option>
<option value="MG">Madagascar, Republic of</option>
<option value="MW">Malawi, Republic of</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives, Republic of</option>
<option value="ML">Mali, Republic of</option>
<option value="MT">Malta, Republic of</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania, Islamic Republic of</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="FM">Micronesia, Federated States of</option>
<option value="MD">Moldova, Republic of</option>
<option value="MC">Monaco, Principality of</option>
<option value="MN">Mongolia, Mongolian People's Republic</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco, Kingdom of</option>
<option value="MZ">Mozambique, People's Republic of</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru, Republic of</option>
<option value="NP">Nepal, Kingdom of</option>
<option value="AN">Netherlands Antilles</option>
<option value="NL">Netherlands, Kingdom of the</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua, Republic of</option>
<option value="NE">Niger, Republic of the</option>
<option value="NG">Nigeria, Federal Republic of</option>
<option value="NU">Niue, Republic of</option>
<option value="NF">Norfolk Island</option>
<option value="MP">Northern Mariana Islands</option>
<option value="NO">Norway, Kingdom of</option>
<option value="OM">Oman, Sultanate of</option>
<option value="PK">Pakistan, Islamic Republic of</option>
<option value="PW">Palau</option>
<option value="PS">Palestinian Territory, Occupied</option>
<option value="PA">Panama, Republic of</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay, Republic of</option>
<option value="PE">Peru, Republic of</option>
<option value="PH">Philippines, Republic of the</option>
<option value="PN">Pitcairn Island</option>
<option value="PL">Poland, Polish People's Republic</option>
<option value="PT">Portugal, Portuguese Republic</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar, State of</option>
<option value="RE">Reunion</option>
<option value="RO">Romania, Socialist Republic of</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda, Rwandese Republic</option>
<option value="WS">Samoa, Independent State of</option>
<option value="SM">San Marino, Republic of</option>
<option value="ST">Sao Tome and Principe, Democratic Republic of</option>
<option value="SA">Saudi Arabia, Kingdom of</option>
<option value="SN">Senegal, Republic of</option>
<option value="CS">Serbia and Montenegro</option>
<option value="SC">Seychelles, Republic of</option>
<option value="SL">Sierra Leone, Republic of</option>
<option value="SG">Singapore, Republic of</option>
<option value="SK">Slovakia (Slovak Republic)</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia, Somali Republic</option>
<option value="ZA">South Africa, Republic of</option>
<option value="GS">South Georgia and the South Sandwich Islands</option>
<option value="ES">Spain, Spanish State</option>
<option value="LK">Sri Lanka, Democratic Socialist Republic of</option>
<option value="SH">St. Helena</option>
<option value="KN">St. Kitts and Nevis</option>
<option value="LC">St. Lucia</option>
<option value="PM">St. Pierre and Miquelon</option>
<option value="VC">St. Vincent and the Grenadines</option>
<option value="SD">Sudan, Democratic Republic of the</option>
<option value="SR">Suriname, Republic of</option>
<option value="SJ">Svalbard & Jan Mayen Islands</option>
<option value="SZ">Swaziland, Kingdom of</option>
<option value="SE">Sweden, Kingdom of</option>
<option value="CH">Switzerland, Swiss Confederation</option>
<option value="SY">Syrian Arab Republic</option>
<option value="TW">Taiwan, Province of China</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania, United Republic of</option>
<option value="TH">Thailand, Kingdom of</option>
<option value="TL">Timor-Leste, Democratic Republic of</option>
<option value="TG">Togo, Togolese Republic</option>
<option value="TK">Tokelau (Tokelau Islands)</option>
<option value="TO">Tonga, Kingdom of</option>
<option value="TT">Trinidad and Tobago, Republic of</option>
<option value="TN">Tunisia, Republic of</option>
<option value="TR">Turkey, Republic of</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda, Republic of</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom of Great Britain & N. Ireland</option>
<option value="UY">Uruguay, Eastern Republic of</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VE">Venezuela, Bolivarian Republic of</option>
<option value="VN">Viet Nam, Socialist Republic of</option>
<option value="WF">Wallis and Futuna Islands</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia, Republic of</option>
<option value="ZW">Zimbabwe</option>
</select>
</div>
</div>
<div class="col-xs-5">
<label for="phone-super-purchase" class="control-label sr-only">Phone</label>
<input id="phone-super-purchase" type="tel" name="phone" class="form-control" placeholder="Phone number">
</div>
</div>
</div>
</fieldset>
<fieldset id="form-payment-tax-detail" class="tnt-tax-detail col-xs-12">
<div class="form-group-flex tax-result">
<div id="tax-subtotal-container"> Subtotal: <span class="tax-subtotal"></span>
</div>
<div id="tax-total-container"> Total: <span class="tax-total"></span>
</div>
</div>
</fieldset>
<fieldset id="form-payment-super-purchase" class="col-xs-12">
<legend>How would you like to pay?</legend>
<div id="tn-pay-method-select-super-purchase" class="form-group" hidden="">
<template id="tn-pay-method-card-template-super-purchase">
<a class="btn btn-lg btn-block btn-default wallet-btn wallet-show-card" title="">
<span class="tn-cc-lg" data-cc=""></span>
<span class="tn-cc-text">
<span class="tn-cc-heading"><span class="tn-cc-ending-in">Ending in <span class="tn-cc-last-four"></span></span>
<span class="tn-cc-label text-muted"></span> <small class="tn-cc-exp"></small>
</span>
</span></a>
</template>
<div id="tn-pay-method-card-data-super-purchase" hidden="">
<template class="visa" data-card="VISA"><svg enable-background="new 0 0 780 500" height="22" viewBox="0 0 780 500" width="34" xmlns="http://www.w3.org/2000/svg">
<path d="m40 0h700c22.092 0 40 17.909 40 40v420c0 22.092-17.908 40-40 40h-700c-22.091 0-40-17.908-40-40v-420c0-22.091 17.909-40 40-40z" fill="#0e4595"></path>
<path
d="m293.2 348.73 33.361-195.76h53.36l-33.385 195.76zm246.11-191.54c-10.57-3.966-27.137-8.222-47.822-8.222-52.725 0-89.865 26.55-90.18 64.603-.299 28.13 26.514 43.822 46.752 53.186 20.771 9.595 27.752 15.714 27.654 24.283-.131 13.121-16.586 19.116-31.922 19.116-21.357 0-32.703-2.967-50.227-10.276l-6.876-3.11-7.489 43.823c12.463 5.464 35.51 10.198 59.438 10.443 56.09 0 92.5-26.246 92.916-66.882.199-22.269-14.016-39.216-44.801-53.188-18.65-9.055-30.072-15.099-29.951-24.268 0-8.137 9.668-16.839 30.557-16.839 17.449-.27 30.09 3.535 39.938 7.5l4.781 2.26zm137.31-4.223h-41.232c-12.773 0-22.332 3.487-27.941 16.234l-79.244 179.4h56.031s9.16-24.123 11.232-29.418c6.125 0 60.555.084 68.338.084 1.596 6.853 6.49 29.334 6.49 29.334h49.514l-43.188-195.64zm-65.418 126.41c4.412-11.279 21.26-54.723 21.26-54.723-.316.522 4.379-11.334 7.074-18.684l3.605 16.879s10.219 46.729 12.354 56.528zm-363.3-126.41-52.24 133.5-5.567-27.13c-9.725-31.273-40.025-65.155-73.898-82.118l47.766 171.2 56.456-.064 84.004-195.39h-56.521"
fill="#fff"></path>
<path d="m146.92 152.96h-86.041l-.681 4.073c66.938 16.204 111.23 55.363 129.62 102.41l-18.71-89.96c-3.23-12.395-12.597-16.094-24.186-16.527" fill="#f2ae14"></path>
</svg></template>
<template class="master" data-card="MasterCard"><svg enable-background="new 0 0 780 500" height="22" viewBox="0 0 780 500" width="34" xmlns="http://www.w3.org/2000/svg">
<path d="m40 0h700c22.092 0 40 17.909 40 40v420c0 22.092-17.908 40-40 40h-700c-22.091 0-40-17.908-40-40v-420c0-22.091 17.909-40 40-40z" fill="#16366f"></path>
<path d="m449.01 250c0 99.143-80.37 179.5-179.51 179.5s-179.5-80.361-179.5-179.5c0-99.133 80.362-179.5 179.5-179.5 99.137 0 179.51 80.37 179.51 179.5" fill="#d9222a"></path>
<path
d="m510.49 70.496c-46.38 0-88.643 17.596-120.5 46.466-6.49 5.889-12.548 12.237-18.125 18.996h36.266c4.966 6.037 9.536 12.388 13.685 19.013h-63.635c-3.827 6.121-7.28 12.469-10.341 19.008h84.312c2.893 6.185 5.431 12.53 7.6 19.004h-99.512c-2.091 6.235-3.832 12.581-5.217 19.009h109.94c2.689 12.49 4.044 25.231 4.041 38.008 0 19.934-3.254 39.113-9.254 57.02h-99.512c2.164 6.479 4.7 12.825 7.595 19.01h84.317c-3.064 6.54-6.52 12.889-10.347 19.013h-63.625c4.154 6.629 8.73 12.979 13.685 18.996h36.258c-5.57 6.772-11.63 13.126-18.13 19.012 31.86 28.867 74.118 46.454 120.5 46.454 99.138-.001 179.51-80.362 179.51-179.5 0-99.13-80.37-179.5-179.51-179.5"
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<span data-cc="american_express" title="American Express" class="allow_announce"><svg enable-background="new 0 0 780 500" height="22" viewBox="0 0 780 500" width="34" xmlns="http://www.w3.org/2000/svg"><path d="m40 .001h700c22.092 0 40 17.909 40 40v420c0 22.092-17.908 40-40 40h-700c-22.091 0-40-17.908-40-40v-420c0-22.091 17.909-40 40-40z" fill="#2557d6"></path><path d="m.253 235.69h37.441l8.442-19.51h18.9l8.42 19.51h73.668v-14.915l6.576 14.98h38.243l6.576-15.202v15.138h183.08l-.085-32.026h3.542c2.479.083 3.204.302 3.204 4.226v27.8h94.689v-7.455c7.639 3.92 19.518 7.455 35.148 7.455h39.836l8.525-19.51h18.9l8.337 19.51h76.765v-18.532l11.626 18.532h61.515v-122.51h-60.88v14.468l-8.522-14.468h-62.471v14.468l-7.828-14.468h-84.38c-14.123 0-26.539 1.889-36.569 7.153v-7.153h-58.229v7.153c-6.383-5.426-15.079-7.153-24.75-7.153h-212.74l-14.274 31.641-14.659-31.641h-67.005v14.468l-7.362-14.468h-57.145l-26.539 58.246v64.261h.003zm236.34-17.67h-22.464l-.083-68.794-31.775 68.793h-19.24l-31.858-68.854v68.854h-44.57l-8.42-19.592h-45.627l-8.505 19.592h-23.801l39.241-87.837h32.559l37.269 83.164v-83.164h35.766l28.678 59.587 26.344-59.587h36.485zm-165.9-37.823-14.998-35.017-14.915 35.017zm255.3 37.821h-73.203v-87.837h73.203v18.291h-51.289v15.833h50.06v18.005h-50.061v17.542h51.289zm103.16-64.18c0 14.004-9.755 21.24-15.439 23.412 4.794 1.748 8.891 4.838 10.84 7.397 3.094 4.369 3.628 8.271 3.628 16.116v17.255h-22.104l-.083-11.077c0-5.285.528-12.886-3.458-17.112-3.202-3.09-8.083-3.76-15.973-3.76h-23.523v31.95h-21.914v-87.838h50.401c11.199 0 19.451.283 26.535 4.207 6.933 3.924 11.09 9.652 11.09 19.45zm-27.699 13.042c-3.013 1.752-6.573 1.81-10.841 1.81h-26.62v-19.51h26.982c3.818 0 7.804.164 10.393 1.584 2.842 1.28 4.601 4.003 4.601 7.765 0 3.84-1.674 6.929-4.515 8.351zm62.844 51.138h-22.358v-87.837h22.358zm259.56 0h-31.053l-41.535-65.927v65.927h-44.628l-8.527-19.592h-45.521l-8.271 19.592h-25.648c-10.649 0-24.138-2.257-31.773-9.715-7.701-7.458-11.708-17.56-11.708-33.533 0-13.027 2.395-24.936 11.812-34.347 7.085-7.01 18.18-10.242 33.28-10.242h21.215v18.821h-20.771c-7.997 0-12.514 1.14-16.862 5.203-3.735 3.699-6.298 10.69-6.298 19.897 0 9.41 1.951 16.196 6.023 20.628 3.373 3.476 9.506 4.53 15.272 4.53h9.842l30.884-69.076h32.835l37.102 83.081v-83.08h33.366l38.519 61.174v-61.174h22.445zm-133.2-37.82-15.165-35.017-15.081 35.017zm189.04 178.08c-5.322 7.457-15.694 11.238-29.736 11.238h-42.319v-18.84h42.147c4.181 0 7.106-.527 8.868-2.175 1.665-1.474 2.605-3.554 2.591-5.729 0-2.561-1.064-4.593-2.677-5.811-1.59-1.342-3.904-1.95-7.722-1.95-20.574-.67-46.244.608-46.244-27.194 0-12.742 8.443-26.156 31.439-26.156h43.649v-17.479h-40.557c-12.237 0-21.129 2.81-27.425 7.174v-7.175h-59.985c-9.595 0-20.854 2.279-26.179 7.175v-7.175h-107.12v7.175c-8.524-5.892-22.908-7.175-29.549-7.175h-70.656v7.175c-6.745-6.258-21.742-7.175-30.886-7.175h-79.077l-18.094 18.764-16.949-18.764h-118.13v122.59h115.9l18.646-19.062 17.565 19.062 71.442.061v-28.838h7.021c9.479.14 20.66-.228 30.523-4.312v33.085h58.928v-31.952h2.842c3.628 0 3.985.144 3.985 3.615v28.333h179.01c11.364 0 23.244-2.786 29.824-7.845v7.845h56.78c11.815 0 23.354-1.587 32.134-5.649l.002-22.84zm-354.94-47.155c0 24.406-19.005 29.445-38.159 29.445h-27.343v29.469h-42.591l-26.984-29.086-28.042 29.086h-86.802v-87.859h88.135l26.961 28.799 27.875-28.799h70.021c17.389 0 36.929 4.613 36.929 28.945zm-174.22 40.434h-53.878v-17.48h48.11v-17.926h-48.11v-15.974h54.939l23.969 25.604zm86.81 10.06-33.644-35.789 33.644-34.65zm49.757-39.066h-28.318v-22.374h28.572c7.912 0 13.404 3.09 13.404 10.772 0 7.599-5.238 11.602-13.658 11.602zm148.36-40.373h73.138v18.17h-51.315v15.973h50.062v17.926h-50.062v17.48l51.314.08v18.23h-73.139zm-28.119 47.029c4.878 1.725 8.865 4.816 10.734 7.375 3.095 4.291 3.542 8.294 3.631 16.037v17.418h-22.002v-10.992c0-5.286.531-13.112-3.542-17.198-3.201-3.147-8.083-3.899-16.076-3.899h-23.42v32.09h-22.02v-87.859h50.594c11.093 0 19.173.47 26.366 4.146 6.915 4.004 11.266 9.487 11.266 19.511-.001 14.022-9.764 21.178-15.531 23.371zm-12.385-11.107c-2.932 1.667-6.556 1.811-10.818 1.811h-26.622v-19.732h26.982c3.902 0 7.807.08 10.458 1.587 2.84 1.423 4.538 4.146 4.538 7.903 0 3.758-1.699 6.786-4.538 8.431zm197.82 5.597c4.27 4.229 6.554 9.571 6.554 18.613 0 18.9-12.322 27.723-34.425 27.723h-42.68v-18.84h42.51c4.157 0 7.104-.525 8.95-2.175 1.508-1.358 2.589-3.333 2.589-5.729 0-2.561-1.17-4.592-2.675-5.811-1.675-1.34-3.986-1.949-7.803-1.949-20.493-.67-46.157.609-46.157-27.192 0-12.744 8.355-26.158 31.33-26.158h43.932v18.7h-40.198c-3.984 0-6.575.145-8.779 1.587-2.4 1.422-3.29 3.534-3.29 6.319 0 3.314 2.037 5.57 4.795 6.546 2.311.77 4.795.995 8.526.995l11.797.306c11.895.276 20.061 2.248 25.024 7.065zm86.955-23.52h-39.938c-3.986 0-6.638.144-8.867 1.587-2.312 1.423-3.202 3.534-3.202 6.322 0 3.314 1.951 5.568 4.791 6.544 2.312.771 4.795.996 8.444.996l11.878.304c11.983.284 19.982 2.258 24.86 7.072.891.67 1.422 1.422 2.033 2.175v-25z" fill="#fff"></path></svg></span>
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<span data-cc="master" title="MasterCard" class="allow_announce"><svg enable-background="new 0 0 780 500" height="22" viewBox="0 0 780 500" width="34" xmlns="http://www.w3.org/2000/svg"><path d="m40 0h700c22.092 0 40 17.909 40 40v420c0 22.092-17.908 40-40 40h-700c-22.091 0-40-17.908-40-40v-420c0-22.091 17.909-40 40-40z" fill="#16366f"></path><path d="m449.01 250c0 99.143-80.37 179.5-179.51 179.5s-179.5-80.361-179.5-179.5c0-99.133 80.362-179.5 179.5-179.5 99.137 0 179.51 80.37 179.51 179.5" fill="#d9222a"></path><path d="m510.49 70.496c-46.38 0-88.643 17.596-120.5 46.466-6.49 5.889-12.548 12.237-18.125 18.996h36.266c4.966 6.037 9.536 12.388 13.685 19.013h-63.635c-3.827 6.121-7.28 12.469-10.341 19.008h84.312c2.893 6.185 5.431 12.53 7.6 19.004h-99.512c-2.091 6.235-3.832 12.581-5.217 19.009h109.94c2.689 12.49 4.044 25.231 4.041 38.008 0 19.934-3.254 39.113-9.254 57.02h-99.512c2.164 6.479 4.7 12.825 7.595 19.01h84.317c-3.064 6.54-6.52 12.889-10.347 19.013h-63.625c4.154 6.629 8.73 12.979 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<div id="tn-pay-manual-entry-super-purchase">
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<label for="spreedly-number-super-purchase" class="sr-only">Credit card</label>
<div id="spreedly-number-super-purchase" class="form-control"></div>
<div id="tn-pay-cards-super-purchase" class="tn-pay-cards pull-right">
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<div class="form-group-flex">
<div id="billing-cvv">
<label for="spreedly-cvv-super-purchase">CVV</label>
<div id="spreedly-cvv-super-purchase" class="form-control"></div>
</div>
<div id="billing-month">
<label for="tnpay-month-super-purchase" class="control-label">Expiration <span class="sr-only">Month</span>
</label>
<select id="tnpay-month-super-purchase" class="form-control" name="tnpay-month">
<option value="1"> Jan </option>
<option value="2" selected=""> Feb </option>
<option value="3"> Mar </option>
<option value="4"> Apr </option>
<option value="5"> May </option>
<option value="6"> Jun </option>
<option value="7"> Jul </option>
<option value="8"> Aug </option>
<option value="9"> Sep </option>
<option value="10"> Oct </option>
<option value="11"> Nov </option>
<option value="12"> Dec </option>
</select>
</div>
<div id="billing-year">
<label for="tnpay-year-super-purchase" class="sr-only"> Expiration year </label>
<select id="tnpay-year-super-purchase" class="form-control" name="tnpay-year">
<option value="2024" selected=""> 2024 </option>
<option value="2025"> 2025 </option>
<option value="2026"> 2026 </option>
<option value="2027"> 2027 </option>
<option value="2028"> 2028 </option>
<option value="2029"> 2029 </option>
<option value="2030"> 2030 </option>
<option value="2031"> 2031 </option>
<option value="2032"> 2032 </option>
<option value="2033"> 2033 </option>
<option value="2034"> 2034 </option>
</select>
</div>
</div>
</div><!-- tn-pay-manual-entry -->
</fieldset>
<fieldset class="col-xs-12">
<div class="form-group tn-tos-group">
<label>
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</label>
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</fieldset>
<div class="form-group text-center"><input type="submit" class="btn btn-primary" id="form-submit-super-purchase" value="Pay Now" disabled="">
</div>
<p class="secure-notice text-center">
<span class="purchase-gift">Secure transaction.</span>
<span class="purchase-standard">Secure transaction. Cancel anytime.</span>
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Dental assistant Kara Simon (left) and Dr. Lydia Goodson work with a client at
Crescent Community Health Center’s dental clinic on Thursday.
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* BY MAIA BOND maia.bond@thmedia.com
MAIA BOND
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* Jan 5, 2024
* Jan 5, 2024 Updated 6 hrs ago
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Dental assistant Kara Simon (left) and Dr. Lydia Goodson work with a client at
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When a second dentist joined Valerie Peckosh’s Dubuque pediatric dentistry
practice in July, the floodgates opened.
With two dentists, Peckosh’s practice can take on more patients with Medicaid.
But the more word gets out, the more calls come in requesting appointments.
She said her practice, Peckosh Pediatric Dentistry, is one of a few pediatric
dentists in Dubuque that accept new Medicaid patients on a relatively open
basis.
Dentists who accept new patients on Medicaid are a rarity in Dubuque, an issue
that leads to lengthy appointment wait times or long drives to other towns for
recipients to access care.
Delta Dental, one of the insurance carriers for Iowa Medicaid recipients,
maintains a list of available dentists who accept recipients of the health care
program serving people with low incomes or disabilities. However, most of the
offices listed as accepting Medicaid in Dubuque said when contacted by the
Telegraph Herald that they do not currently accept Medicaid or only accept it
for existing patients.
Many local providers say low Medicaid reimbursement rates make it nearly
impossible to afford taking on new Medicaid patients.
“The reimbursement rates come in somewhere around 38 cents on the dollar,”
Peckosh said. “A lot of offices, that’s barely going to hit their overhead, or
doesn’t. The reimbursement rates make it really difficult, particularly for
certain types of practices, to see a lot of Medicaid.”
She said new or smaller offices might find it difficult to take on many Medicaid
patients because they don’t have the client volume to absorb the lost money. The
administrative burden associated with taking Medicaid patients also is taxing
for offices, Peckosh said.
Peckosh said her associate dentist recently asked when they will need to stop
accepting new patients.
“I just told her, ‘Well, we’ll take as many as we can for as long as we can. But
at some point, we have to stop taking new (patients) so we can catch up with the
backlog,’” Peckosh said.
The issue spreads beyond Dubuque, though. Leaders in the dental industry say it
is a statewide problem.
Iowa Rep. Steve Bradley, R-Cascade, who is a dentist, said he has advocated for
decades to increase the Medicaid reimbursement rate for Iowa dentists. Bradley
has served stints as president of the Iowa Dental Association and on the Iowa
Dental Board.
Right now, he said, it is cheaper for him to give care for free than to accept
Medicaid because reimbursement rates don’t even cover the administrative costs.
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“You have to take five to 10 regular pay patients just to break even,” Bradley
said.
Kiane Smith, I-Smile and oral health coordinator at UnityPoint Health-Visiting
Nurse Association, said a lack of dentists who accept new Medicaid patients is
the main struggle she sees for prospective patients across Iowa.
“We’re in a bit of a crisis throughout the state on dental access to care,”
Smith said. “A lot of children that we see and pregnant women that we identify
with (dental) decay have to travel far out of the county to get care or they
have to wait upward of like six months if they don’t already have an established
dentist.”
Families who are new to the area or have switched to Medicaid struggle to find a
dental office, she said. While local dentists sometimes accept referrals from
Smith when they have time, general access to care for Medicaid recipients is
low, she said.
While advocates and dentists primarily call for increasing reimbursement rates,
local initiatives also seek to alleviate the problem.
Dental health was identified as one of three major priorities in the latest
Dubuque County Community Health Assessment and Improvement Plan, which outlined
several strategies to address oral health locally. Those strategies include
creating an oral health advisory board on which local dental leaders can work
together on initiatives.
Smith also stressed the importance of increased education and awareness about
oral health. If families can’t see a dentist, Smith said, they at least should
receive education on proper oral hygiene and on tobacco use.
“(Education) is important to us just to make sure that everybody can have a base
knowledge of oral health to hopefully prevent some of this decay that we see
throughout the community,” Smith said.
Crescent Community Health Center’s dental clinic, which serves many Dubuque
residents who are uninsured or on Medicaid, also is set to expand this year to
increase capacity particularly for oral surgery and pediatric care. The clinic
also will add a dental care mobile unit in the coming months.
Until then, dental clinic manager Diana Gau said Crescent is at capacity to
serve dental patients.
“It is a struggle right now until the expansion is done,” Gau said. “Right now
what we’re trying to do is plan as best that we can.”
Gau said because many patients cannot easily access dental care — whether
because local dentists don’t accept Medicaid or the patients are uninsured — it
isn’t a priority for them until they are in pain. When patients don’t receive
care until they are in a lot of pain, care can become more complicated and
emergency-based, she said.
Oral health also can affect overall health and wellness. Gau said chronic
infections in the mouth affect the whole body, including conditions such as high
blood pressure and diabetes.
Maia Bond is a Report For America corps member.
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word word word word word word word word word word word word word word word word
word word word word word word word word word word word word word word word word
word word word word word word word word word word word word word word word word
word word word word word word word word word word word word word word word word
word word word word word word word word word word word word word word word word
word word word word word word word word word word word word word word word word
word word word word word word word word word word word word word word word word
word word word word word word word word word word word word word word word word
word word word word word word word word word word word word word word word word
word word word word word word word word word word word word word word word word
word word word word word word word word
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