donatella.ir Open in urlscan Pro
172.67.210.141  Public Scan

Form analysis
4 forms found in the DOM

Name: donAmount —

<form name="donAmount" id="donAmount">
  <input type="radio" value="3" name="amount" id="three">
  <label for="three">$3</label>
  <input type="radio" value="25" name="amount" id="twentyfive">
  <label for="twentyfive">$25</label>
  <input type="radio" value="100" name="amount" id="hundred">
  <label for="hundred">$100</label>
  <input type="radio" value="other" name="amount" id="other">
  <label for="other">Other</label>
</form>

Name: customDonation —

<form name="customDonation" id="customDonation">
  <div class="input-group-1">
    <label for="custom-amount">$</label>
    <input id="custom-amount" name="custom-amount" type="text">
    <div class="warn"></div>
  </div>
</form>

<form class="clearfix">
  <div class="input-group-2">
    <label>First Name</label>
    <input type="text">
  </div>
  <div class="input-group-2">
    <label>Last Name</label>
    <input type="text">
  </div>
  <div class="input-group-1">
    <label>Email Address</label>
    <input type="text">
  </div>
  <hr>
  <div class="input-group-1">
    <label>Street Address</label>
    <input type="text">
  </div>
  <div class="input-group-3">
    <label>City</label>
    <input type="text">
  </div>
  <div class="input-group-3">
    <label>State</label>
    <input type="text">
  </div>
  <div class="input-group-3">
    <label>Zip Code</label>
    <input type="text">
  </div>
</form>

<form class="clearfix">
  <div class="input-group-1">
    <label>Card Number</label>
    <input type="text">
  </div>
  <div class="clearfix">
    <div class="input-group-2">
      <label>Expiration Date</label>
      <input type="text">
    </div>
    <div class="input-group-2">
      <label>Security Code (CVV)</label>
      <input type="text">
    </div>
  </div>
  <hr>
  <div class="input-group-1">
    <label>Employer</label>
    <input type="text">
  </div>
  <div class="input-group-1">
    <label>Occupation</label>
    <input type="text">
  </div>
</form>

Text Content

Donate
$3 $25 $100 Other


DONATION AMOUNT

$

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BASIC INFORMATION

First Name
Last Name
Email Address

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Street Address
City
State
Zip Code
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PAYMENT INFORMATION

Card Number
Expiration Date
Security Code (CVV)

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Employer
Occupation
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CONFIRM PAYMENT

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$8888 Confirm


THANK YOU!

Your $25 donation will help us reach 570!