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Submission: On May 29 via manual from US — Scanned from US
Submission: On May 29 via manual from US — Scanned from US
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<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="2024-05-28">
</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">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" selected="">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="7" 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">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" selected="">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">
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<path
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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>
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<path
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fill="#ee9f2d"></path>
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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>
</div>
<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"> Feb </option>
<option value="3"> Mar </option>
<option value="4"> Apr </option>
<option value="5"> May </option>
<option value="6" selected=""> 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>
<input id="tn-tos-super-purchase" type="checkbox" name="tos_confirm">
<span class="tn-tos-agree">I Agree to the Subscription <a class="tos-link" href="https://upstatetoday.com/site/terms.html">Terms of Use.</a>
</span>
<br>
<small class="service-renews purchase-standard" hidden="">This service will be automatically renewed and your credit card billed once it nears expiration.</small>
</label>
</div>
</fieldset>
<div class="form-group text-center"><input type="submit" class="btn btn-primary tn-pay-button" 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>
</p>
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Many Oconee County residents have been impacted by the disagreement between
Prisma Health and UnitedHealthcare which led to recipients being out-of-network
in coverage since January.
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Many Oconee County residents have been impacted by the disagreement between
Prisma Health and UnitedHealthcare which led to recipients being out-of-network
in coverage since January.
FILE
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SENECA — Nancy Jeffers, a retired pediatrician who practiced under her maiden
name Nancy Cheney, sympathizes with the people — a large number of them senior
citizens — impacted by Prisma Health and health insurance provider United
Healthcare’s inability to resolve an impasse that has led to recipients being
out-of-network coverage since Jan. 1.
But Jeffers also emphasized that not all of those under a UnitedHealthcare plan
have been impacted — including herself.
“Those of us who have traditional Medicare using UnitedHealthcare as our Medigap
plan, we aren’t having any problem,” Jeffers told The Journal. “Life is going on
as usual. We knew with traveling and stuff that we wanted a plan that would not
limit us as a network. The problem with networks is you never know when your
physician might drop out of your network or the network may not have the
specialist you need.
“With UnitedHealthcare there are no limitations, no network — we can see anybody
we want, and we generally don’t require referrals and there’s no prior
authorization,” she continued. “That’s one of the big drawbacks of Medicare
Advantage — that it can really delay things and delay things that can become
life threatening. That, to me, is pretty bad.”
Jeffers added that on initial application, once a person turns 65, any Medigap
plan has to accept them regardless of their circumstances. But for those
attempting to get out of a Medicare Advantage Plan, they do not have to be
accepted.
“They can do one of three things — they can accept you at traditional rates if
you’re extraordinarily healthy, can accept you but will charge you more than
what you would have to pay otherwise — and it ends up generally being
significantly more that makes up for any savings you would have with Medicare
Advantage — or they can outright refuse you,” she said. “The insurance companies
do underwriting and if they don’t like the results of their underwriting, they
can say ‘Sorry. You’re not eligible. We’re not going to take you.’ That’s the
big risk.”
Jeffers said she first picked up UnitedHealthcare upon leaving her private
practice in California and “no longer carried a policy that covered all of us.”
“We bought an RV and sold everything that didn’t fit in a 40-foot RV or a 5X10
storage unit,” she said. “If we had a plan that had a network, we would be out
of network all the time.”
Having spent more than 50 years in the medical profession (from 1959-2015),
Jeffers said a number of physicians and medical groups are dropping out of
participation in the Medicare Advantage Plan “probably because they’re so
frustrated with the rules and regs (regulations) and especially the prior
auth(orization).”
“People who make the decisions for prior auth(orization) frequently are totally
unqualified to be making the kinds of decisions they’re making,” Jeffers said.
Negotiations ongoing
As of May 16, officials with Prisma Health and UnitedHealthcare say both sides
are still in negotiations for a new agreement.
Out of network plans include: UnitedHealthcare (all commercial),
UnitedHealthcare Medicare Advantage, Logistic Health Inc., Optum Behavioral
Health and Spectera Eyecare Network.
Out-of-network patients can still receive emergency services at Prisma Health.
More information on the status of negotiations is available at prismahealth.org
or uhc.com.
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