palo-alto-u.myshopify.com Open in urlscan Pro
2620:127:f00f:e::  Public Scan

Submitted URL: https://palo-alto-u.myshopify.com/60312125673/checkouts/61269cf12aae7cf5dad49c5d07e72fcf?key=0d639247c06e395d98f31f11400c3e84
Effective URL: https://palo-alto-u.myshopify.com/checkouts/co/61269cf12aae7cf5dad49c5d07e72fcf
Submission: On March 29 via manual from US — Scanned from US

Form analysis 3 forms found in the DOM

POST

<form action="" method="POST" novalidate="" id="Form0" class="_1fragemki">
  <div class="_1fragemir">
    <div class="_1ip0g651 _1fragemkn _1fragemir _1frageml6 _1fragemlo _1fragemci _1fragemf0 _1fragema0 _1fragemhi">
      <div class="jvovV">
        <section class="_1fragemk5 _1fragemk1 _1fragemkh _1fragemb9 _1fragemcj _1fragemdr _1fragemf1 _1fragem8r _1fragema1 _1fragemg9 _1fragemhj _1fragemro _1fragemir">
          <div class="_1ip0g651 _1fragemkn _1fragemir _1fragemlh _1fragemlz">
            <div class="_1fragemkh _1fragemir">
              <div>
                <div class="UxvQ2">
                  <h2 class="aHlIb">Express checkout</h2>
                </div>
                <div class="lAHfA">
                  <div class="i7LZd">
                    <div id="express-checkout-wallets-wrapper" class="_19K_ A35vI lRMEA">
                      <a id="shop-pay-button" href="https://palo-alto-u.myshopify.com/checkouts/co/61269cf12aae7cf5dad49c5d07e72fcf?payment=shop_pay&amp;redirect_source=direct_checkout_checkout" aria-label="Shop Pay" class="KVEbf"><svg xmlns="http://www.w3.org/2000/svg" fill="inherit" aria-hidden="true" preserveAspectRatio="xMidYMid" viewBox="0 0 341 80.035" class="P3VGi" style="fill: white;"><path fill-rule="evenodd" d="M227.297 0c-6.849 0-12.401 5.472-12.401 12.223v55.59c0 6.75 5.552 12.222 12.401 12.222h101.06c6.849 0 12.401-5.472 12.401-12.222v-55.59c0-6.75-5.552-12.223-12.401-12.223zm17.702 55.892v-14.09h8.994c8.217 0 12.586-4.542 12.586-11.423s-4.369-11-12.586-11h-14.788v36.513zm0-31.084h7.664c5.319 0 7.932 2.154 7.932 5.758s-2.518 5.758-7.695 5.758h-7.901zm31.796 31.833c4.417 0 7.314-1.92 8.644-5.196.38 3.65 2.613 5.523 7.457 4.26l.048-3.886c-1.948.187-2.328-.515-2.328-2.528v-9.55c0-5.617-3.752-8.94-10.686-8.94-6.84 0-10.782 3.37-10.782 9.08h5.32c0-2.714 1.947-4.353 5.367-4.353 3.609 0 5.272 1.545 5.224 4.214v1.217l-6.127.655c-6.887.749-10.686 3.324-10.686 7.818 0 3.698 2.659 7.209 8.549 7.209m1.187-4.213c-2.992 0-4.179-1.592-4.179-3.184 0-2.153 2.47-3.136 7.314-3.698l3.8-.421c-.238 4.12-3.04 7.303-6.935 7.303m32.555 5.29c-2.422 5.804-6.317 7.536-12.396 7.536h-2.613V60.48h2.803c3.324 0 4.939-1.03 6.697-3.979l-10.782-24.95h5.984l7.695 18.21 6.839-18.21h5.842z" clip-rule="evenodd"></path><path d="M29.514 35.18c-7.934-1.697-11.469-2.36-11.469-5.374 0-2.834 2.392-4.246 7.176-4.246 4.207 0 7.283 1.813 9.546 5.363.171.274.524.369.812.222l8.927-4.447a.616.616 0 0 0 .256-.864c-3.705-6.332-10.55-9.798-19.562-9.798-11.843 0-19.2 5.752-19.2 14.898 0 9.714 8.96 12.169 16.904 13.865 7.944 1.697 11.49 2.36 11.49 5.374s-2.584 4.435-7.742 4.435c-4.763 0-8.297-2.15-10.433-6.321a.63.63 0 0 0-.843-.274L6.47 52.364a.623.623 0 0 0-.278.843c3.535 7.006 10.785 10.947 20.47 10.947 12.334 0 19.787-5.658 19.787-15.088s-9.001-12.169-16.935-13.865zM77.353 16.036c-5.062 0-9.536 1.77-12.75 4.92-.203.19-.534.053-.534-.221V.622a.62.62 0 0 0-.63-.622h-11.17a.62.62 0 0 0-.63.622v62.426a.62.62 0 0 0 .63.621h11.17a.62.62 0 0 0 .63-.621V35.664c0-5.289 4.11-9.345 9.653-9.345 5.542 0 9.557 3.972 9.557 9.345v27.384a.62.62 0 0 0 .63.621h11.17a.62.62 0 0 0 .63-.621V35.664c0-11.505-7.646-19.618-18.356-19.618zM118.389 14.255c-6.065 0-11.767 1.823-15.847 4.467a.62.62 0 0 0-.202.833l4.922 8.292c.182.295.566.4.865.22a19.8 19.8 0 0 1 10.262-2.78c9.749 0 16.914 6.785 16.914 15.75 0 7.64-5.734 13.297-13.006 13.297-5.926 0-10.037-3.403-10.037-8.207 0-2.75 1.185-5.005 4.271-6.596a.607.607 0 0 0 .246-.864l-4.645-7.754a.63.63 0 0 0-.759-.264c-6.225 2.276-10.593 7.755-10.593 15.109 0 11.126 8.981 19.428 21.507 19.428 14.629 0 25.147-9.998 25.147-24.338 0-15.372-12.237-26.603-29.066-26.603zM180.098 15.952c-5.649 0-10.689 2.054-14.373 5.678a.313.313 0 0 1-.534-.22v-4.363a.62.62 0 0 0-.63-.621H153.68a.62.62 0 0 0-.63.621v62.331a.62.62 0 0 0 .63.622h11.169a.62.62 0 0 0 .631-.622v-20.44c0-.274.331-.41.533-.231 3.674 3.371 8.532 5.342 14.096 5.342 13.102 0 23.321-10.463 23.321-24.054 0-13.592-10.23-24.054-23.321-24.054zm-2.103 37.54c-7.454 0-13.103-5.848-13.103-13.582 0-7.733 5.638-13.58 13.103-13.58s13.091 5.752 13.091 13.58-5.553 13.581-13.102 13.581z"></path></svg></a>
                    </div>
                  </div>
                </div>
              </div>
            </div>
          </div>
          <div class="_1fragemkh _1fragemb4 _1fragemf0 _1fragem8w _1fragemhi _1fragemir">
            <div role="separator" class="_1fragemir mg7oix1 mg7oix9 _1fragemmj mg7oixc _1fragemkj _1fragemjf _1fragemjb mg7oixg mg7oix3">
              <div class="mg7oixl">
                <p class="_1x52f9s1 _1fragemir _1x52f9so _1fragemkv _1fragemqv"><span class="_19gi7yt0 _19gi7ytl _1fragemkv _19gi7ytb">OR</span></p>
              </div>
            </div>
          </div>
          <div class="_1ip0g651 _1fragemkn _1fragemir _1fragemlh _1fragemlz">
            <div>
              <div>
                <div>
                  <div class="Giv21">
                    <h2 class="n8k95w1 _1fragemir n8k95w2">Contact</h2>
                  </div>
                  <div class="_16s97g75k"></div>
                  <div class="_1ip0g651 _1fragemkn _1fragemir _1frageml6 _1fragemlo">
                    <div class="_1fragemir _1fragemkn _1frageml6 _1fragemlo _1fragemj6 _16s97g7f _16s97g7p _16s97g71j _16s97g71t" style="--_16s97g7a: 1fr; --_16s97g7k: minmax(0, 1fr); --_16s97g71e: minmax(0, 1fr); --_16s97g71o: minmax(0, 1fr);">
                      <div class="_7ozb2u2 _1frageml2 _1fragemlk _1fragemir _1fragemkn _10vrn9p1 _10vrn9p0 _10vrn9p4 _1fragemk6">
                        <div class="_1fragemir"><label id="email-label" for="email" class="cektnc3 _1fragemih _1fragemqt _1fragemqc _1fragemri _1fragemr7 _1fragemr2 _1fragemrg"><span class="cektnc9"><span
                                class="rermvf1 _1fragemq9 _1fragemqb _1fragemkh">Email</span></span></label>
                          <div class="_7ozb2u6 _1fragemir _1fragemkn _1fragemkg _1fragemr7 _1fragemr2 _1fragemrg _1fragemrh _1fragemk6 _1fragemro _7ozb2ul _7ozb2uh _7ozb2u8"><input id="email" name="email" placeholder="Email" type="email"
                              aria-labelledby="email-label" autocomplete="billing email" data-protected-input="true" class="_7ozb2uq _1fragemir _1fragemri _1fragemmj _1fragemqs _7ozb2ur _7ozb2u12 _7ozb2u1j" autofocus="true"></div>
                        </div>
                      </div>
                    </div>
                    <div class="xMIj4"></div>
                  </div>
                </div>
              </div>
            </div>
          </div>
        </section>
        <div class="_16s97g75a _16s97g765"></div>
        <section aria-label="Payment" class="_1fragemk5 _1fragemk1 _1fragemkh _1fragemb9 _1fragemcj _1fragemdr _1fragemf1 _1fragem8r _1fragema1 _1fragemg9 _1fragemhj _1fragemro _1fragemir">
          <div>
            <div>
              <div class="_1ip0g651 _1fragemkn _1fragemir _1frageml6 _1fragemlo">
                <div class="_1ip0g651 _1fragemkn _1fragemir _1frageml2 _1fragemlk">
                  <h2 class="n8k95w1 _1fragemir n8k95w2">Payment</h2>
                  <p class="_1x52f9s1 _1fragemir _1x52f9so _1fragemkv _1x52f9si">All transactions are secure and encrypted.</p>
                </div>
                <div class="_1ip0g651 _1fragemkn _1fragemir _1fragemla _1fragemls">
                  <div class="_1ip0g651 _1fragemkn _1fragemir _1frageml9 _1fragemlr">
                    <div class="_1ip0g651 _1fragemkn _1fragemir _1frageml6 _1fragemlo">
                      <div>
                        <div class="_1ip0g651 _1fragemkn _1fragemir _1frageml6 _1fragemlo">
                          <fieldset id="basic">
                            <legend class="_1fragemqu">Choose a payment method</legend>
                            <div class="Wo4qW ezrb1p3 _1fragemk6 _1fragemro NDMe9 NdTJE PuVf0">
                              <div class="B4zH6 Zb82w HKtYc OpmPd">
                                <div class="yL8c2 ezrb1p5 _1fragemk7">
                                  <div class="f5aCe">
                                    <div><span class="_19gi7yt0 _19gi7ytl _1fragemkv">Credit card</span></div>
                                    <div>
                                      <div class="wAAjh">
                                        <div class="_1fragemkj _1fragemir _1fragemmn">
                                          <div class="_5uqybw2 _1fragemkj _1fragemhx _1frageml2 _1fragemlk _1fragemjb _1fragemjf _1fragemmn"><img alt="VISA" src="https://cdn.shopify.com/shopifycloud/checkout-web/assets/0169695890db3db16bfe.svg"
                                              role="img" width="38" height="24" class="_1tgdqw61 _1fragemr7 _1fragemr2 _1fragemrg _1fragemmi"><img alt="MASTERCARD"
                                              src="https://cdn.shopify.com/shopifycloud/checkout-web/assets/ae9ceec48b1dc489596c.svg" role="img" width="38" height="24" class="_1tgdqw61 _1fragemr7 _1fragemr2 _1fragemrg _1fragemmi"><img alt="AMEX"
                                              src="https://cdn.shopify.com/shopifycloud/checkout-web/assets/f11b90c2972f3811f2d5.svg" role="img" width="38" height="24" class="_1tgdqw61 _1fragemr7 _1fragemr2 _1fragemrg _1fragemmi"><img alt="DISCOVER"
                                              src="https://cdn.shopify.com/shopifycloud/checkout-web/assets/4cde67b4ecfa33d21851.svg" role="img" width="38" height="24" class="_1tgdqw61 _1fragemr7 _1fragemr2 _1fragemrg _1fragemmi"><button
                                              type="button" aria-pressed="false" class="_1xqelvi1 _1fragemkf _1fragemkh _1fragemir _1fragemqx _1fragemr7 _1fragemr2 _1fragemrg _1fragemkj _1fragemkp _1fragemjf _1fragemml cb5z9"><span
                                                class="_19gi7yt0 _19gi7ytj _1fragemku _19gi7yt1 _19gi7yt4">+4</span></button></div>
                                        </div>
                                      </div>
                                    </div>
                                  </div>
                                </div>
                                <div id="basic-creditCards-collapsible" class="_94sxtb1 _1fragemq9 _1fragemqb _1fragemir _1fragemr9 _1fragemrd _1fragemr3" style="height: auto; overflow: visible;">
                                  <div>
                                    <div class="b7U_P">
                                      <div class="_1ip0g651 _1fragemkn _1fragemir _1frageml6 _1fragemlo">
                                        <div id="directPaymentMethodDetails" class="_94sxtb1 _1fragemq9 _1fragemqb _1fragemir _1fragemr9 _1fragemrd _1fragemr3" style="height: auto; overflow: visible;">
                                          <div>
                                            <div class="_1ip0g651 _1fragemkn _1fragemir _1frageml6 _1fragemlo">
                                              <div>
                                                <div class="jNSGe">
                                                  <div class="_1ip0g651 _1fragemkn _1fragemir _1frageml6 _1fragemlo">
                                                    <div class="apbd6 _10vrn9p1 _10vrn9p0 _10vrn9p4 _1fragemk6">
                                                      <div class="_1fragemir"><label id="number-label" for="number" class="cektnc3 _1fragemih _1fragemqt _1fragemqc _1fragemri _1fragemr7 _1fragemr2 _1fragemrg"><span class="cektnc9"><span
                                                              class="rermvf1 _1fragemq9 _1fragemqb _1fragemkh">Card number</span></span></label>
                                                        <div data-protected-input="true" class="oT32G B46er _1fragemk6 Xkh0E IbLRo">
                                                          <div id="number" data-card-fields="number" data-card-field-placeholder="Card number" data-card-field-prefix="Field container for:" tabindex="-1" class="xIN8V F8weU"><iframe
                                                              class="card-fields-iframe" frameborder="0" id="card-fields-number-57cibdbhb4f00000-scope-palo-alto-u.myshopify.com"
                                                              name="card-fields-number-57cibdbhb4f00000-scope-palo-alto-u.myshopify.com" scrolling="no" src="https://checkout.shopifycs.com/number?identifier=&amp;location=&amp;dir=ltr"
                                                              title="Field container for: Card number" style="height: 48px;"></iframe></div>
                                                          <div class="P7KAT"><span class="_1fragemmj _1fragem2i _1fragemhs _1fragemhn a8x1wu3 _1fragemkh a8x1wui a8x1wum"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 14 14" focusable="false"
                                                                aria-hidden="true" class="a8x1wuo _1fragemkh _1fragemmj _1fragemhs _1fragemhn">
                                                                <path stroke-linecap="round" stroke-linejoin="round"
                                                                  d="M3.5 6.3c0-2.298 1.131-4.9 3.5-4.9s3.5 2.602 3.5 4.9m-8.4.47v5.36c0 .26.21.47.47.47h8.86c.26 0 .47-.21.47-.47V6.77a.47.47 0 0 0-.47-.47H2.57a.47.47 0 0 0-.47.47"></path>
                                                              </svg></span></div>
                                                        </div>
                                                      </div>
                                                    </div>
                                                    <div class="T50Pa Layout0 PypyI rhUtJ">
                                                      <style>
                                                        .Layout0>.i602M> :nth-child(1) {
                                                          flex: 0 0 100%;
                                                        }

                                                        .Layout0>.i602M> :nth-child(2) {
                                                          flex: 0 0 100%;
                                                        }

                                                        .Layout0>.i602M> :nth-child(3) {
                                                          flex: 0 0 100%;
                                                        }

                                                        .Layout0>.i602M {
                                                          flex-wrap: wrap;
                                                        }

                                                        @media all and (min-width: 750px) {
                                                          .Layout0>.i602M> :nth-child(1) {
                                                            flex: 1 0px;
                                                          }

                                                          .Layout0>.i602M> :nth-child(2) {
                                                            flex: 1 0px;
                                                          }

                                                          .Layout0>.i602M> :nth-child(3) {
                                                            flex: 1 0px;
                                                          }

                                                          .Layout0>.i602M {
                                                            flex-wrap: nowrap;
                                                          }
                                                        }
                                                      </style>
                                                      <div class="i602M T9faX">
                                                        <div class="qyWc2">
                                                          <div>
                                                            <div>
                                                              <div class="apbd6 _10vrn9p1 _10vrn9p0 _10vrn9p4 _1fragemk6">
                                                                <div class="_1fragemir"><label id="expiry-label" for="expiry" class="cektnc3 _1fragemih _1fragemqt _1fragemqc _1fragemri _1fragemr7 _1fragemr2 _1fragemrg"><span class="cektnc9"><span
                                                                        class="rermvf1 _1fragemq9 _1fragemqb _1fragemkh">Expiration date (MM / YY)</span></span></label>
                                                                  <div data-protected-input="true" class="oT32G B46er _1fragemk6 Xkh0E IbLRo">
                                                                    <div id="expiry" data-card-fields="expiry" data-card-field-placeholder="Expiration date (MM / YY)" data-card-field-prefix="Field container for:" tabindex="-1" class="xIN8V"><iframe
                                                                        class="card-fields-iframe" frameborder="0" id="card-fields-expiry-ocbz8veq12i00000-scope-palo-alto-u.myshopify.com"
                                                                        name="card-fields-expiry-ocbz8veq12i00000-scope-palo-alto-u.myshopify.com" scrolling="no" src="https://checkout.shopifycs.com/expiry?identifier=&amp;location=&amp;dir=ltr"
                                                                        title="Field container for: Expiration date (MM / YY)" style="height: 48px;"></iframe></div>
                                                                  </div>
                                                                </div>
                                                              </div>
                                                            </div>
                                                          </div>
                                                        </div>
                                                        <div class="qyWc2">
                                                          <div>
                                                            <div>
                                                              <div class="apbd6 _10vrn9p1 _10vrn9p0 _10vrn9p4 _1fragemk6">
                                                                <div class="_1fragemir"><label id="verification_value-label" for="verification_value" class="cektnc3 _1fragemih _1fragemqt _1fragemqc _1fragemri _1fragemr7 _1fragemr2 _1fragemrg"><span
                                                                      class="cektnc9"><span class="rermvf1 _1fragemq9 _1fragemqb _1fragemkh">Security code</span></span></label>
                                                                  <div data-protected-input="true" class="oT32G B46er _1fragemk6 Xkh0E IbLRo">
                                                                    <div id="verification_value" data-card-fields="verification_value" data-card-field-placeholder="Security code" data-card-field-prefix="Field container for:" tabindex="-1"
                                                                      class="xIN8V F8weU"><iframe class="card-fields-iframe" frameborder="0" id="card-fields-verification_value-00q5ro5sibqim000-scope-palo-alto-u.myshopify.com"
                                                                        name="card-fields-verification_value-00q5ro5sibqim000-scope-palo-alto-u.myshopify.com" scrolling="no"
                                                                        src="https://checkout.shopifycs.com/verification_value?identifier=&amp;location=&amp;dir=ltr" title="Field container for: Security code" style="height: 48px;"></iframe></div>
                                                                    <div class="P7KAT"><button type="button" class="_1xqelvi1 _1fragemkf _1fragemkh _1fragemir _1fragemqx _1fragemr7 _1fragemr2 _1fragemrg _1fragemkj _1fragemji"><span
                                                                          class="_1xqelvi2"><span class="_1fragemmj _1fragem2i _1fragemhs _1fragemhn a8x1wu3 _1fragemkh a8x1wui a8x1wum"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 14 14"
                                                                              focusable="false" aria-label="More information" class="a8x1wuo _1fragemkh _1fragemmj _1fragemhs _1fragemhn">
                                                                              <circle cx="7" cy="7" r="5.6"></circle>
                                                                              <path stroke-linecap="round" stroke-linejoin="round" d="M5.6 5.1c.2-1.3 2.6-1.3 2.8 0S6.95 6.4 6.95 7.45m.055 2.35H7v.005h.005z"></path>
                                                                              <circle cx="7" cy="9.7" r="0.1"></circle>
                                                                            </svg></span></span></button></div>
                                                                  </div>
                                                                </div>
                                                              </div>
                                                            </div>
                                                          </div>
                                                        </div>
                                                      </div>
                                                    </div>
                                                    <div hidden="">
                                                      <div class="T50Pa Layout1 PypyI rhUtJ">
                                                        <style>
                                                          .Layout1>.i602M> :nth-child(1) {
                                                            flex: 0 0 100%;
                                                          }

                                                          .Layout1>.i602M> :nth-child(2) {
                                                            flex: 0 0 100%;
                                                          }

                                                          .Layout1>.i602M> :nth-child(3) {
                                                            flex: 0 0 100%;
                                                          }

                                                          .Layout1>.i602M {
                                                            flex-wrap: wrap;
                                                          }

                                                          @media all and (min-width: 750px) {
                                                            .Layout1>.i602M> :nth-child(1) {
                                                              flex: 1 0px;
                                                            }

                                                            .Layout1>.i602M> :nth-child(2) {
                                                              flex: 1 0px;
                                                            }

                                                            .Layout1>.i602M> :nth-child(3) {
                                                              flex: 1 0px;
                                                            }

                                                            .Layout1>.i602M {
                                                              flex-wrap: nowrap;
                                                            }
                                                          }
                                                        </style>
                                                        <div class="i602M T9faX">
                                                          <div class="qyWc2">
                                                            <div>
                                                              <div>
                                                                <div class="apbd6 _10vrn9p1 _10vrn9p0 _10vrn9p4 _1fragemk6">
                                                                  <div class="_1fragemir"><label id="issue_date-label" for="issue_date" class="cektnc3 _1fragemih _1fragemqt _1fragemqc _1fragemri _1fragemr7 _1fragemr2 _1fragemrg"><span
                                                                        class="cektnc9"><span class="rermvf1 _1fragemq9 _1fragemqb _1fragemkh">Issue date (MM / YY)</span></span></label>
                                                                    <div data-protected-input="true" hidden="" class="oT32G B46er _1fragemk6 Xkh0E IbLRo">
                                                                      <div id="issue_date" data-card-fields="issue_date" data-card-field-placeholder="Issue date (MM / YY)" data-card-field-prefix="Field container for:" tabindex="-1" class="xIN8V">
                                                                        <iframe class="card-fields-iframe" frameborder="0" id="card-fields-issue_date-70jggupu0rh00000-scope-palo-alto-u.myshopify.com"
                                                                          name="card-fields-issue_date-70jggupu0rh00000-scope-palo-alto-u.myshopify.com" scrolling="no"
                                                                          src="https://checkout.shopifycs.com/issue_date?identifier=&amp;location=&amp;dir=ltr" title="Field container for: Issue date (MM / YY)"></iframe></div>
                                                                      <div class="uG6K1 DOldf">
                                                                        <div class="IesQp"></div>
                                                                      </div>
                                                                    </div>
                                                                  </div>
                                                                </div>
                                                              </div>
                                                            </div>
                                                          </div>
                                                          <div class="qyWc2">
                                                            <div>
                                                              <div>
                                                                <div class="apbd6 _10vrn9p1 _10vrn9p0 _10vrn9p4 _1fragemk6">
                                                                  <div class="_1fragemir"><label id="issue_number-label" for="issue_number" class="cektnc3 _1fragemih _1fragemqt _1fragemqc _1fragemri _1fragemr7 _1fragemr2 _1fragemrg"><span
                                                                        class="cektnc9"><span class="rermvf1 _1fragemq9 _1fragemqb _1fragemkh">Issue number</span></span></label>
                                                                    <div data-protected-input="true" hidden="" class="oT32G B46er _1fragemk6 Xkh0E IbLRo">
                                                                      <div id="issue_number" data-card-fields="issue_number" data-card-field-placeholder="Issue number" data-card-field-prefix="Field container for:" tabindex="-1" class="xIN8V"><iframe
                                                                          class="card-fields-iframe" frameborder="0" id="card-fields-issue_number-1bb4733ttrki0000-scope-palo-alto-u.myshopify.com"
                                                                          name="card-fields-issue_number-1bb4733ttrki0000-scope-palo-alto-u.myshopify.com" scrolling="no"
                                                                          src="https://checkout.shopifycs.com/issue_number?identifier=&amp;location=&amp;dir=ltr" title="Field container for: Issue number"></iframe></div>
                                                                      <div class="uG6K1 DOldf">
                                                                        <div class="IesQp"></div>
                                                                      </div>
                                                                    </div>
                                                                  </div>
                                                                </div>
                                                              </div>
                                                            </div>
                                                          </div>
                                                        </div>
                                                      </div>
                                                    </div>
                                                    <div>
                                                      <div class="apbd6 _10vrn9p1 _10vrn9p0 _10vrn9p4 _1fragemk6">
                                                        <div class="_1fragemir"><label id="name-label" for="name" class="cektnc3 _1fragemih _1fragemqt _1fragemqc _1fragemri _1fragemr7 _1fragemr2 _1fragemrg"><span class="cektnc9"><span
                                                                class="rermvf1 _1fragemq9 _1fragemqb _1fragemkh">Name on card</span></span></label>
                                                          <div data-protected-input="true" class="oT32G B46er _1fragemk6 Xkh0E IbLRo">
                                                            <div id="name" data-card-fields="name" data-card-field-placeholder="Name on card" data-card-field-prefix="Field container for:" tabindex="-1" class="B_pnJ"><iframe class="card-fields-iframe"
                                                                frameborder="0" id="card-fields-name-rcq7lm8n5yo00000-scope-palo-alto-u.myshopify.com" name="card-fields-name-rcq7lm8n5yo00000-scope-palo-alto-u.myshopify.com" scrolling="no"
                                                                src="https://checkout.shopifycs.com/name?identifier=&amp;location=&amp;dir=ltr" title="Field container for: Name on card" style="height: 48px;"></iframe></div>
                                                          </div>
                                                        </div>
                                                      </div>
                                                    </div>
                                                  </div>
                                                </div>
                                              </div>
                                            </div>
                                          </div>
                                        </div>
                                      </div>
                                    </div>
                                  </div>
                                </div>
                              </div>
                            </div>
                          </fieldset>
                        </div>
                      </div>
                    </div>
                    <div class="_1ip0g651 _1fragemkn _1fragemir _1frageml6 _1fragemlo">
                      <h2 class="n8k95w1 _1fragemir n8k95w3">Billing address</h2>
                      <div class="_1fragemir">
                        <div id="billingAddressForm">
                          <div aria-hidden="false" class="pxSEU">
                            <div class="_1ip0g651 _1fragemkn _1fragemir _1frageml6 _1fragemlo">
                              <div class="_1fragemir _1fragemkn _1frageml6 _1fragemlo _1fragemj6 _1fragemj2 _16s97g7f _16s97g7p _16s97g71j _16s97g71t"
                                style="--_16s97g7a: minmax(0, 1fr); --_16s97g7k: minmax(0, 1fr); --_16s97g71e: minmax(0, 1fr); --_16s97g71o: minmax(0, 1fr);">
                                <div class="vTXBW _1fragemk6 _10vrn9p1 _10vrn9p0 _10vrn9p4">
                                  <div>
                                    <div class="j2JE7 _1fragemk6"><label for="Select0" class="QOQ2V NKh24"><span class="KBYKh"><span class="rermvf1 _1fragemq9 _1fragemqb _1fragemkh">Country/Region</span></span></label><select name="countryCode"
                                        id="Select0" required="" autocomplete="billing country" form="Form1" class="_b6uH _1fragemro yA4Q8 vYo81 RGaKd">
                                        <option value="US">United States</option>
                                        <option value="CA">Canada</option>
                                        <option value="AU">Australia</option>
                                        <option value="NZ">New Zealand</option>
                                        <option disabled="" value="">---</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="AG">Antigua &amp; Barbuda</option>
                                        <option value="AR">Argentina</option>
                                        <option value="AM">Armenia</option>
                                        <option value="AW">Aruba</option>
                                        <option value="AC">Ascension Island</option>
                                        <option value="AU">Australia</option>
                                        <option value="AT">Austria</option>
                                        <option value="AZ">Azerbaijan</option>
                                        <option value="BS">Bahamas</option>
                                        <option value="BH">Bahrain</option>
                                        <option value="BD">Bangladesh</option>
                                        <option value="BB">Barbados</option>
                                        <option value="BY">Belarus</option>
                                        <option value="BE">Belgium</option>
                                        <option value="BZ">Belize</option>
                                        <option value="BJ">Benin</option>
                                        <option value="BM">Bermuda</option>
                                        <option value="BT">Bhutan</option>
                                        <option value="BO">Bolivia</option>
                                        <option value="BA">Bosnia &amp; Herzegovina</option>
                                        <option value="BW">Botswana</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</option>
                                        <option value="BG">Bulgaria</option>
                                        <option value="BF">Burkina Faso</option>
                                        <option value="BI">Burundi</option>
                                        <option value="KH">Cambodia</option>
                                        <option value="CM">Cameroon</option>
                                        <option value="CA">Canada</option>
                                        <option value="CV">Cape Verde</option>
                                        <option value="BQ">Caribbean Netherlands</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 - Brazzaville</option>
                                        <option value="CD">Congo - Kinshasa</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="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</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="HN">Honduras</option>
                                        <option value="HK">Hong Kong SAR</option>
                                        <option value="HU">Hungary</option>
                                        <option value="IS">Iceland</option>
                                        <option value="IN">India</option>
                                        <option value="ID">Indonesia</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="XK">Kosovo</option>
                                        <option value="KW">Kuwait</option>
                                        <option value="KG">Kyrgyzstan</option>
                                        <option value="LA">Laos</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 SAR</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="MD">Moldova</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 (Burma)</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="PS">Palestinian Territories</option>
                                        <option value="PA">Panama</option>
                                        <option value="PG">Papua New Guinea</option>
                                        <option value="PY">Paraguay</option>
                                        <option value="PE">Peru</option>
                                        <option value="PH">Philippines</option>
                                        <option value="PN">Pitcairn Islands</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">Russia</option>
                                        <option value="RW">Rwanda</option>
                                        <option value="WS">Samoa</option>
                                        <option value="SM">San Marino</option>
                                        <option value="ST">São Tomé &amp; Príncipe</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</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 &amp; South Sandwich Islands</option>
                                        <option value="KR">South Korea</option>
                                        <option value="SS">South Sudan</option>
                                        <option value="ES">Spain</option>
                                        <option value="LK">Sri Lanka</option>
                                        <option value="BL">St. Barthélemy</option>
                                        <option value="SH">St. Helena</option>
                                        <option value="KN">St. Kitts &amp; Nevis</option>
                                        <option value="LC">St. Lucia</option>
                                        <option value="MF">St. Martin</option>
                                        <option value="PM">St. Pierre &amp; Miquelon</option>
                                        <option value="VC">St. Vincent &amp; Grenadines</option>
                                        <option value="SD">Sudan</option>
                                        <option value="SR">Suriname</option>
                                        <option value="SJ">Svalbard &amp; Jan Mayen</option>
                                        <option value="SE">Sweden</option>
                                        <option value="CH">Switzerland</option>
                                        <option value="TW">Taiwan</option>
                                        <option value="TJ">Tajikistan</option>
                                        <option value="TZ">Tanzania</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 &amp; Tobago</option>
                                        <option value="TA">Tristan da Cunha</option>
                                        <option value="TN">Tunisia</option>
                                        <option value="TR">Türkiye</option>
                                        <option value="TM">Turkmenistan</option>
                                        <option value="TC">Turks &amp; Caicos Islands</option>
                                        <option value="TV">Tuvalu</option>
                                        <option value="UM">U.S. Outlying Islands</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="UY">Uruguay</option>
                                        <option value="UZ">Uzbekistan</option>
                                        <option value="VU">Vanuatu</option>
                                        <option value="VA">Vatican City</option>
                                        <option value="VE">Venezuela</option>
                                        <option value="VN">Vietnam</option>
                                        <option value="WF">Wallis &amp; Futuna</option>
                                        <option value="EH">Western Sahara</option>
                                        <option value="YE">Yemen</option>
                                        <option value="ZM">Zambia</option>
                                        <option value="ZW">Zimbabwe</option>
                                      </select>
                                      <div class="TUEJq"><span class="_1fragemmj _1fragem2i _1fragemhs _1fragemhn a8x1wu3 _1fragemkh a8x1wug a8x1wum"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 14 14" focusable="false" aria-hidden="true"
                                            class="a8x1wuo _1fragemkh _1fragemmj _1fragemhs _1fragemhn">
                                            <path stroke-linecap="round" stroke-linejoin="round" d="m11.9 5.6-4.653 4.653a.35.35 0 0 1-.495 0L2.1 5.6"></path>
                                          </svg></span></div>
                                    </div>
                                  </div>
                                </div>
                              </div>
                              <div class="_1fragemir _1fragemkn _1frageml6 _1fragemlo _1fragemj6 _1fragemj2 _16s97g7f _16s97g7p _16s97g71j _16s97g71t"
                                style="--_16s97g7a: minmax(0, 1fr); --_16s97g7k: minmax(0, 1fr); --_16s97g71e: minmax(0, 1fr); --_16s97g71o: minmax(0, 1fr);">
                                <div class="_7ozb2u2 _1frageml2 _1fragemlk _1fragemir _1fragemkn _10vrn9p1 _10vrn9p0 _10vrn9p4 _1fragemk6">
                                  <div class="_1fragemir"><label id="TextField0-label" for="TextField0" class="cektnc3 _1fragemih _1fragemqt _1fragemqc _1fragemri _1fragemr7 _1fragemr2 _1fragemrg"><span class="cektnc9"><span
                                          class="rermvf1 _1fragemq9 _1fragemqb _1fragemkh">First name</span></span></label>
                                    <div class="_7ozb2u6 _1fragemir _1fragemkn _1fragemkg _1fragemr7 _1fragemr2 _1fragemrg _1fragemrh _1fragemk6 _1fragemro _7ozb2ul _7ozb2uh"><input id="TextField0" name="firstName" placeholder="First name"
                                        required="" type="text" aria-required="true" aria-labelledby="TextField0-label" autocomplete="billing given-name" form="Form1" data-protected-input="true"
                                        class="_7ozb2uq _1fragemir _1fragemri _1fragemmj _1fragemqs _7ozb2ur _7ozb2u11 _7ozb2u1j"></div>
                                  </div>
                                </div>
                                <div class="_7ozb2u2 _1frageml2 _1fragemlk _1fragemir _1fragemkn _10vrn9p1 _10vrn9p0 _10vrn9p4 _1fragemk6">
                                  <div class="_1fragemir"><label id="TextField1-label" for="TextField1" class="cektnc3 _1fragemih _1fragemqt _1fragemqc _1fragemri _1fragemr7 _1fragemr2 _1fragemrg"><span class="cektnc9"><span
                                          class="rermvf1 _1fragemq9 _1fragemqb _1fragemkh">Last name</span></span></label>
                                    <div class="_7ozb2u6 _1fragemir _1fragemkn _1fragemkg _1fragemr7 _1fragemr2 _1fragemrg _1fragemrh _1fragemk6 _1fragemro _7ozb2ul _7ozb2uh"><input id="TextField1" name="lastName" placeholder="Last name" required=""
                                        type="text" aria-required="true" aria-labelledby="TextField1-label" autocomplete="billing family-name" form="Form1" data-protected-input="true"
                                        class="_7ozb2uq _1fragemir _1fragemri _1fragemmj _1fragemqs _7ozb2ur _7ozb2u11 _7ozb2u1j"></div>
                                  </div>
                                </div>
                              </div>
                              <div class="_1fragemir _1fragemkn _1frageml6 _1fragemlo _1fragemj6 _1fragemj2 _16s97g7f _16s97g7p _16s97g71j _16s97g71t"
                                style="--_16s97g7a: minmax(0, 1fr); --_16s97g7k: minmax(0, 1fr); --_16s97g71e: minmax(0, 1fr); --_16s97g71o: minmax(0, 1fr);">
                                <div class="_7ozb2u2 _1frageml2 _1fragemlk _1fragemir _1fragemkn _10vrn9p1 _10vrn9p0 _10vrn9p4 _1fragemk6">
                                  <div class="_1fragemir"><label id="TextField2-label" for="TextField2" class="cektnc3 _1fragemih _1fragemqt _1fragemqc _1fragemri _1fragemr7 _1fragemr2 _1fragemrg"><span class="cektnc9"><span
                                          class="rermvf1 _1fragemq9 _1fragemqb _1fragemkh">Company</span></span></label>
                                    <div class="_7ozb2u6 _1fragemir _1fragemkn _1fragemkg _1fragemr7 _1fragemr2 _1fragemrg _1fragemrh _1fragemk6 _1fragemro _7ozb2ul _7ozb2uh"><input id="TextField2" name="company" placeholder="Company" required=""
                                        type="text" aria-required="true" aria-labelledby="TextField2-label" autocomplete="billing organization" form="Form1" class="_7ozb2uq _1fragemir _1fragemri _1fragemmj _1fragemqs _7ozb2ur _7ozb2u11 _7ozb2u1j">
                                    </div>
                                  </div>
                                </div>
                              </div>
                              <div class="_1fragemir _1fragemkn _1frageml6 _1fragemlo _1fragemj6 _1fragemj2 _16s97g7f _16s97g7p _16s97g71j _16s97g71t"
                                style="--_16s97g7a: minmax(0, 1fr); --_16s97g7k: minmax(0, 1fr); --_16s97g71e: minmax(0, 1fr); --_16s97g71o: minmax(0, 1fr);">
                                <div class="Vob8N R5Ptu">
                                  <div class="_1ip0g651 _1fragemkn _1fragemir _1frageml4 _1fragemlm">
                                    <div>
                                      <div class="_7ozb2u2 _1frageml2 _1fragemlk _1fragemir _1fragemkn _10vrn9p1 _10vrn9p0 _10vrn9p4 _1fragemk6">
                                        <div class="_1fragemir"><label id="billing-address1-label" for="billing-address1" class="cektnc3 _1fragemih _1fragemqt _1fragemqc _1fragemri _1fragemr7 _1fragemr2 _1fragemrg"><span class="cektnc9"><span
                                                class="rermvf1 _1fragemq9 _1fragemqb _1fragemkh">Address</span></span></label>
                                          <div class="_7ozb2u6 _1fragemir _1fragemkn _1fragemkg _1fragemr7 _1fragemr2 _1fragemrg _1fragemrh _1fragemk6 _1fragemro _7ozb2ul _7ozb2uh"><input id="billing-address1" name="address1" placeholder="Address"
                                              required="" type="text" aria-autocomplete="list" aria-controls="billing-address1-options" aria-owns="billing-address1-options" aria-expanded="false" aria-required="true"
                                              aria-labelledby="billing-address1-label" aria-haspopup="listbox" role="combobox" autocomplete="billing address-line1" form="Form1" autocorrect="off" data-protected-input="true"
                                              class="_7ozb2uq _1fragemir _1fragemri _1fragemmj _1fragemqs _7ozb2ur _1fragemn5 _1fragemnf _7ozb2u11 _7ozb2u1j">
                                            <div class="_1fragemir _1fragemri _1fragemjk _1fragemkd _7ozb2u1g"><span class="_1fragemmj _1fragem2i _1fragemhs _1fragemhn a8x1wu3 _1fragemkh a8x1wui a8x1wum"><svg xmlns="http://www.w3.org/2000/svg"
                                                  viewBox="0 0 14 14" focusable="false" aria-hidden="true" class="a8x1wuo _1fragemkh _1fragemmj _1fragemhs _1fragemhn">
                                                  <path stroke-linecap="round" d="M9.16 9.159a4.194 4.194 0 1 0-5.933-5.93 4.194 4.194 0 0 0 5.934 5.93Zm0 0L12.6 12.6"></path>
                                                </svg></span></div>
                                          </div>
                                        </div>
                                      </div>
                                    </div>
                                  </div>
                                </div>
                              </div>
                              <div class="_Yuii">
                                <div class="I9W0A">
                                  <div id="collapsed-fields" class="_94sxtb1 _1fragemq9 _1fragemqb _1fragemir _1fragemr9 _1fragemrd _1fragemr3" style="height: auto; overflow: visible;">
                                    <div>
                                      <div class="_1ip0g651 _1fragemkn _1fragemir _1frageml6 _1fragemlo">
                                        <div class="_1fragemir _1fragemkn _1frageml6 _1fragemlo _1fragemj6 _1fragemj2 _16s97g7f _16s97g7p _16s97g71j _16s97g71t"
                                          style="--_16s97g7a: minmax(0, 1fr); --_16s97g7k: minmax(0, 1fr); --_16s97g71e: minmax(0, 1fr); --_16s97g71o: minmax(0, 1fr);">
                                          <div class="_1fragemkh _1fragemci _1fragemf0 _1fragema0 _1fragemfu _1fragemir"><span><button type="button" class="QT4by eVFmT janiy adBMs EP07D"><span class="AjwsM">
                                                  <div class="_1fragemkj _1fragemir _1fragemmn">
                                                    <div class="_5uqybw2 _1fragemkj _1fragemhx _1frageml2 _1fragemlk _1fragemjb _1fragemjf _1fragemmn"><span class="_1fragemmj _1fragem2i _1fragemhs _1fragemhn a8x1wua _1fragemkh a8x1wug a8x1wum"><svg
                                                          xmlns="http://www.w3.org/2000/svg" viewBox="0 0 14 14" focusable="false" aria-hidden="true" class="a8x1wuo _1fragemkh _1fragemmj _1fragemhs _1fragemhn">
                                                          <path stroke-linecap="round" d="M2.1 7H7m4.9 0H7m0 0V2.1M7 7v4.9"></path>
                                                        </svg></span>Add apartment, suite, etc.</div>
                                                  </div>
                                                </span></button></span></div>
                                        </div>
                                        <div class="_1fragemir _1fragemkn _1frageml6 _1fragemlo _1fragemj6 _1fragemj2 _16s97g7f _16s97g7p _16s97g71j _16s97g71t"
                                          style="--_16s97g7a: minmax(0, 1fr); --_16s97g7k: minmax(0, 1fr); --_16s97g71e: minmax(0, 1fr); --_16s97g71o: minmax(0, 1fr);">
                                          <div class="_7ozb2u2 _1frageml2 _1fragemlk _1fragemir _1fragemkn _10vrn9p1 _10vrn9p0 _10vrn9p4 _1fragemk6">
                                            <div class="_1fragemir"><label id="TextField3-label" for="TextField3" class="cektnc3 _1fragemih _1fragemqt _1fragemqc _1fragemri _1fragemr7 _1fragemr2 _1fragemrg"><span class="cektnc9"><span
                                                    class="rermvf1 _1fragemq9 _1fragemqb _1fragemkh">City</span></span></label>
                                              <div class="_7ozb2u6 _1fragemir _1fragemkn _1fragemkg _1fragemr7 _1fragemr2 _1fragemrg _1fragemrh _1fragemk6 _1fragemro _7ozb2ul _7ozb2uh"><input id="TextField3" name="city" placeholder="City" required=""
                                                  type="text" aria-required="true" aria-labelledby="TextField3-label" autocomplete="billing address-level2" form="Form1"
                                                  class="_7ozb2uq _1fragemir _1fragemri _1fragemmj _1fragemqs _7ozb2ur _7ozb2u11 _7ozb2u1j"></div>
                                            </div>
                                          </div>
                                          <div class="vTXBW _1fragemk6 _10vrn9p1 _10vrn9p0 _10vrn9p4">
                                            <div>
                                              <div class="j2JE7 _1fragemk6"><label for="Select1" class="QOQ2V NKh24"><span class="KBYKh"><span class="rermvf1 _1fragemq9 _1fragemqb _1fragemkh">State</span></span></label><select name="zone"
                                                  id="Select1" required="" autocomplete="billing address-level1" form="Form1" class="_b6uH _1fragemro yA4Q8 vYo81 RGaKd">
                                                  <option data-alternate-values="[&quot;Alabama&quot;]" value="AL">Alabama</option>
                                                  <option data-alternate-values="[&quot;Alaska&quot;]" value="AK">Alaska</option>
                                                  <option data-alternate-values="[&quot;American Samoa&quot;]" value="AS">American Samoa</option>
                                                  <option data-alternate-values="[&quot;Arizona&quot;]" value="AZ">Arizona</option>
                                                  <option data-alternate-values="[&quot;Arkansas&quot;]" value="AR">Arkansas</option>
                                                  <option data-alternate-values="[&quot;California&quot;]" value="CA">California</option>
                                                  <option data-alternate-values="[&quot;Colorado&quot;]" value="CO">Colorado</option>
                                                  <option data-alternate-values="[&quot;Connecticut&quot;]" value="CT">Connecticut</option>
                                                  <option data-alternate-values="[&quot;Delaware&quot;]" value="DE">Delaware</option>
                                                  <option data-alternate-values="[&quot;Federated States of Micronesia&quot;,&quot;Micronesia&quot;]" value="FM">Micronesia</option>
                                                  <option data-alternate-values="[&quot;Florida&quot;]" value="FL">Florida</option>
                                                  <option data-alternate-values="[&quot;Georgia&quot;]" value="GA">Georgia</option>
                                                  <option data-alternate-values="[&quot;Guam&quot;]" value="GU">Guam</option>
                                                  <option data-alternate-values="[&quot;Hawaii&quot;]" value="HI">Hawaii</option>
                                                  <option data-alternate-values="[&quot;Idaho&quot;]" value="ID">Idaho</option>
                                                  <option data-alternate-values="[&quot;Illinois&quot;]" value="IL">Illinois</option>
                                                  <option data-alternate-values="[&quot;Indiana&quot;]" value="IN">Indiana</option>
                                                  <option data-alternate-values="[&quot;Iowa&quot;]" value="IA">Iowa</option>
                                                  <option data-alternate-values="[&quot;Kansas&quot;]" value="KS">Kansas</option>
                                                  <option data-alternate-values="[&quot;Kentucky&quot;]" value="KY">Kentucky</option>
                                                  <option data-alternate-values="[&quot;Louisiana&quot;]" value="LA">Louisiana</option>
                                                  <option data-alternate-values="[&quot;Maine&quot;]" value="ME">Maine</option>
                                                  <option data-alternate-values="[&quot;Marshall Islands&quot;]" value="MH">Marshall Islands</option>
                                                  <option data-alternate-values="[&quot;Maryland&quot;]" value="MD">Maryland</option>
                                                  <option data-alternate-values="[&quot;Massachusetts&quot;]" value="MA">Massachusetts</option>
                                                  <option data-alternate-values="[&quot;Michigan&quot;]" value="MI">Michigan</option>
                                                  <option data-alternate-values="[&quot;Minnesota&quot;]" value="MN">Minnesota</option>
                                                  <option data-alternate-values="[&quot;Mississippi&quot;]" value="MS">Mississippi</option>
                                                  <option data-alternate-values="[&quot;Missouri&quot;]" value="MO">Missouri</option>
                                                  <option data-alternate-values="[&quot;Montana&quot;]" value="MT">Montana</option>
                                                  <option data-alternate-values="[&quot;Nebraska&quot;]" value="NE">Nebraska</option>
                                                  <option data-alternate-values="[&quot;Nevada&quot;]" value="NV">Nevada</option>
                                                  <option data-alternate-values="[&quot;New Hampshire&quot;]" value="NH">New Hampshire</option>
                                                  <option data-alternate-values="[&quot;New Jersey&quot;]" value="NJ">New Jersey</option>
                                                  <option data-alternate-values="[&quot;New Mexico&quot;]" value="NM">New Mexico</option>
                                                  <option data-alternate-values="[&quot;New York&quot;]" value="NY">New York</option>
                                                  <option data-alternate-values="[&quot;North Carolina&quot;]" value="NC">North Carolina</option>
                                                  <option data-alternate-values="[&quot;North Dakota&quot;]" value="ND">North Dakota</option>
                                                  <option data-alternate-values="[&quot;Northern Mariana Islands&quot;]" value="MP">Northern Mariana Islands</option>
                                                  <option data-alternate-values="[&quot;Ohio&quot;]" value="OH">Ohio</option>
                                                  <option data-alternate-values="[&quot;Oklahoma&quot;]" value="OK">Oklahoma</option>
                                                  <option data-alternate-values="[&quot;Oregon&quot;]" value="OR">Oregon</option>
                                                  <option data-alternate-values="[&quot;Palau&quot;]" value="PW">Palau</option>
                                                  <option data-alternate-values="[&quot;Pennsylvania&quot;]" value="PA">Pennsylvania</option>
                                                  <option data-alternate-values="[&quot;Puerto Rico&quot;]" value="PR">Puerto Rico</option>
                                                  <option data-alternate-values="[&quot;Rhode Island&quot;]" value="RI">Rhode Island</option>
                                                  <option data-alternate-values="[&quot;South Carolina&quot;]" value="SC">South Carolina</option>
                                                  <option data-alternate-values="[&quot;South Dakota&quot;]" value="SD">South Dakota</option>
                                                  <option data-alternate-values="[&quot;Tennessee&quot;]" value="TN">Tennessee</option>
                                                  <option data-alternate-values="[&quot;Texas&quot;]" value="TX">Texas</option>
                                                  <option data-alternate-values="[&quot;Utah&quot;]" value="UT">Utah</option>
                                                  <option data-alternate-values="[&quot;Vermont&quot;]" value="VT">Vermont</option>
                                                  <option data-alternate-values="[&quot;Virginia&quot;]" value="VA">Virginia</option>
                                                  <option data-alternate-values="[&quot;Washington&quot;]" value="WA">Washington</option>
                                                  <option data-alternate-values="[&quot;District of Columbia&quot;,&quot;Washington DC&quot;]" value="DC">Washington DC</option>
                                                  <option data-alternate-values="[&quot;West Virginia&quot;]" value="WV">West Virginia</option>
                                                  <option data-alternate-values="[&quot;Wisconsin&quot;]" value="WI">Wisconsin</option>
                                                  <option data-alternate-values="[&quot;Wyoming&quot;]" value="WY">Wyoming</option>
                                                  <option data-alternate-values="[&quot;Virgin Islands&quot;,&quot;U.S. Virgin Islands&quot;]" value="VI">U.S. Virgin Islands</option>
                                                  <option data-alternate-values="[&quot;Armed Forces Americas&quot;]" value="AA">Armed Forces Americas</option>
                                                  <option data-alternate-values="[&quot;Armed Forces Europe&quot;]" value="AE">Armed Forces Europe</option>
                                                  <option data-alternate-values="[&quot;Armed Forces Pacific&quot;]" value="AP">Armed Forces Pacific</option>
                                                </select>
                                                <div class="TUEJq"><span class="_1fragemmj _1fragem2i _1fragemhs _1fragemhn a8x1wu3 _1fragemkh a8x1wug a8x1wum"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 14 14" focusable="false"
                                                      aria-hidden="true" class="a8x1wuo _1fragemkh _1fragemmj _1fragemhs _1fragemhn">
                                                      <path stroke-linecap="round" stroke-linejoin="round" d="m11.9 5.6-4.653 4.653a.35.35 0 0 1-.495 0L2.1 5.6"></path>
                                                    </svg></span></div>
                                              </div>
                                            </div>
                                          </div>
                                          <div class="ii1aN">
                                            <div class="_7ozb2u2 _1frageml2 _1fragemlk _1fragemir _1fragemkn _10vrn9p1 _10vrn9p0 _10vrn9p4 _1fragemk6">
                                              <div class="_1fragemir"><label id="TextField4-label" for="TextField4" class="cektnc3 _1fragemih _1fragemqt _1fragemqc _1fragemri _1fragemr7 _1fragemr2 _1fragemrg"><span class="cektnc9"><span
                                                      class="rermvf1 _1fragemq9 _1fragemqb _1fragemkh">ZIP code</span></span></label>
                                                <div class="_7ozb2u6 _1fragemir _1fragemkn _1fragemkg _1fragemr7 _1fragemr2 _1fragemrg _1fragemrh _1fragemk6 _1fragemro _7ozb2ul _7ozb2uh"><input id="TextField4" name="postalCode" placeholder="ZIP code"
                                                    required="" type="text" inputmode="text" aria-required="true" aria-labelledby="TextField4-label" autocomplete="billing postal-code" form="Form1" autocapitalize="characters"
                                                    class="_7ozb2uq _1fragemir _1fragemri _1fragemmj _1fragemqs _7ozb2ur _7ozb2u11 _7ozb2u1j"></div>
                                              </div>
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                            </div>
                            <div class="_1fragemkh _1fragemqu _1fragemir"><input tabindex="-1" label="" aria-hidden="true" aria-label="no-label" type="text" id="autofill_firstName" name="firstName" autocomplete="billing given-name"
                                form="Form1"><input tabindex="-1" label="" aria-hidden="true" aria-label="no-label" type="text" id="autofill_lastName" name="lastName" autocomplete="billing family-name" form="Form1"><input tabindex="-1" label=""
                                aria-hidden="true" aria-label="no-label" type="text" id="autofill_company" name="company" autocomplete="billing organization" form="Form1"><input tabindex="-1" label="" aria-hidden="true" aria-label="no-label"
                                type="text" id="autofill_address1" name="address1" autocomplete="billing address-line1" form="Form1"><input tabindex="-1" label="" aria-hidden="true" aria-label="no-label" type="text" id="autofill_address2"
                                name="address2" autocomplete="billing address-line2" form="Form1"><input tabindex="-1" label="" aria-hidden="true" aria-label="no-label" type="text" id="autofill_city" name="city" autocomplete="billing address-level2"
                                form="Form1"><input tabindex="-1" label="" aria-hidden="true" aria-label="no-label" type="text" id="autofill_country" name="country" autocomplete="billing country" form="Form1"><input tabindex="-1" label=""
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                                id="autofill_address_level1" name="address-level1" autocomplete="billing address-level1" form="Form1"><input tabindex="-1" label="" aria-hidden="true" aria-label="no-label" type="text" id="autofill_province"
                                name="province" autocomplete="billing address-level1" form="Form1"><input tabindex="-1" label="" aria-hidden="true" aria-label="no-label" type="text" id="autofill_postalCode" name="postalCode"
                                autocomplete="billing postal-code" form="Form1"></div>
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LIVE: Use of Violence Risk Assessment to Guide Treatment Planning in Forensic
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