www.coralive.org
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2606:4700:3031::ac43:c935
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URL:
https://www.coralive.org/en/donation
Submission: On February 06 via manual from DE — Scanned from DE
Submission: On February 06 via manual from DE — Scanned from DE
Form analysis 3 forms found in the DOM
POST /en/change/locale
<form id="locale-switcher-form" method="POST" action="/en/change/locale" class="ml-2">
<input type="hidden" value="locale-switcher-form" name="nemesis_form_widget_code">
<select id="localeSelectInput" class="form-control mr-md-2 mr-0" name="value">
<option value="en">English</option>
<option value="fr">French</option>
<option value="de" selected="">German</option>
</select>
<span class="dynamicform-messages mt-2 ml-2"></span>
</form>POST
<form id="coral-2277-default-form-renew-subscription" method="POST" action=""> <input type="hidden" name="stored_customer_firstname" class="field-stored_customer_firstname"> <input type="hidden" name="stored_customer_lastname"
class="field-stored_customer_lastname"> <input type="hidden" name="stored_customer_email" class="field-stored_customer_email"> <!-- required parameters --> <input type="hidden" name="currency" value="chf" class="field-currency"> <input
type="hidden" name="language" value="en" class="field-language"> <input type="hidden" name="reqtype" value="CAA" class="field-reqtype"> <input type="hidden" name="payment_method" value="" class="field-payment_method"> <input type="hidden"
name="recurring" value="" class="field-recurring"> <input type="hidden" name="recurring_interval" value="" class="field-recurring_interval"> <input type="hidden" name="immediate_execution" value="true" class="field-immediate_execution"> <input
type="hidden" name="recurring_interval_name" value="" class="field-recurring_interval_name"> <input type="hidden" name="epayment_finalstatus_timeout" value="" class="field-epayment_finalstatus_timeout"> <input type="hidden"
name="no_dd_validation" value="true" class="field-no_dd_validation"> <input type="hidden" name="meta_recurring" value="" class="field-meta_recurring"> <input type="hidden" name="es_message" value="" class="field-es_message"> <input type="hidden"
name="amount" value="" class="field-amount"> <input type="hidden" name="css_url" value="" class="field-css_url"> <input type="hidden" name="return_parameters" value="true" class="field-return_parameters"> <input type="hidden"
name="stored_rnw_product_name" value="lema" class="field-stored_rnw_product_name"> <input type="hidden" name="stored_rnw_product_version" value="1.25.0" class="field-stored_rnw_product_version"> <input type="hidden" name="stored_rnw_source_url"
value="" class="field-stored_rnw_source_url"> <input type="hidden" name="stored_campaign_id" value="" class="field-stored_campaign_id"> <input type="hidden" name="stored_campaign_subid" value="" class="field-stored_campaign_subid"> <input
type="hidden" name="subscription_token" class="field-subscription_token"> <input type="hidden" name="stored_rnw_purpose_text" class="field-stored_rnw_purpose_text"> <input type="hidden" name="stored_rnw_hide_address_fields" value="false"
class="field-stored_rnw_hide_address_fields"> <input type="hidden" name="stored_translated_recurring_interval" class="field-stored_translated_recurring_interval">
<div data-meta-method="cc" class="lema-payment-item">
<div class="lema-step-row lema-card-icons lema-step-row-cc-icons">
<div data-card-type="vis" class="lema-cc-icon lema-cc-icon-visa"></div>
<div data-card-type="cb" class="lema-cc-icon lema-hidden lema-cc-icon-cb"></div>
<div data-card-type="amx" class="lema-cc-icon lema-cc-icon-amx"></div>
<div data-card-type="eca" class="lema-cc-icon lema-cc-icon-master"></div>
<div data-card-type="din" class="lema-cc-icon lema-hidden lema-cc-icon-diners"></div>
<div data-card-type="jcb" class="lema-cc-icon lema-hidden lema-cc-icon-jcb"></div>
</div>
<div id="lema-cardno-container" class="lema-step-row"> <input id="coral-2277-default-cardno" type="text" class="lema-input-text field-cardno" name="cardno" placeholder="Card Number"> </div>
<div class="lema-step-row lema-step-row-input-right">
<div class="lema-expire-wrapper">
<div class="lema-pseudo-label">Date of expiry:</div> <input type="text" class="lema-input-text lema-input-text-small field-expm" id="coral-2277-default-expm" name="expm" placeholder="MM"> <input type="text"
class="lema-input-text lema-input-text-small field-expy" id="coral-2277-default-expy" name="expy" placeholder="YY">
</div>
<div class="lema-cvc-wrapper">
<div class="lema-pseudo-label">CVV:</div>
<div class="lema-cvc-popup"> <a href="#" tabindex="-1" class="lema-info-icon lema-popup-open"></a>
<div class="lema-popup"> <a href="" class="lema-popup-close"></a>
<div class="lema-popup-content">
<p>These are the last 3 digits on the signature strip on the back of your card. </p>
</div>
<div class="lema-popup-edge"></div>
</div>
</div> <input type="text" class="lema-input-text lema-input-text-small field-cvv" id="coral-2277-default-cvv" name="cvv" placeholder="">
</div>
</div>
<div class="lema-step-row"> <a href="#" tabindex="-1" class="lema-info-icon lema-popup-open">Note on paying by credit card</a>
<div class="lema-popup"> <a href="" class="lema-popup-close"></a>
<div class="lema-popup-content"> <strong>Security:</strong><br>All information exchanged during credit card donations is SSL-encrypted. This data can neither be detected, intercepted nor used by third parties. Information is also not stored
in our data systems. <br><br><strong>Note:</strong><br> The donation will be accepted by the organisation FairGive and then passed directly to Coralive.org in a safe and trustworthy manner. <div class="lema-popup-images"> <img
src="https://lema.raisenow.com/widgets/lema/_default/img/visa_verified.png"> <img src="https://lema.raisenow.com/widgets/lema/_default/img/mastercard_secure.png"> </div>
</div>
<div class="lema-popup-edge"></div>
</div>
</div>
</div>
</form>POST
<form id="coral-2277-default-form" class="lema-full-form" method="POST" action="" accept-charset="UTF-8" novalidate="novalidate"> <!-- required parameters --> <input type="hidden" name="currency" value="chf" class="field-currency"> <input
type="hidden" name="language" value="en" class="field-language"> <input type="hidden" name="reqtype" value="CAA" class="field-reqtype"> <input type="hidden" name="payment_method" value="" class="field-payment_method"> <input type="hidden"
name="recurring" value="false" class="field-recurring"> <input type="hidden" name="recurring_interval" value="" class="field-recurring_interval"> <input type="hidden" name="immediate_execution" value="true" class="field-immediate_execution">
<input type="hidden" name="recurring_interval_name" value="default" class="field-recurring_interval_name"> <input type="hidden" name="epayment_finalstatus_timeout" value="" class="field-epayment_finalstatus_timeout"> <input type="hidden"
name="no_dd_validation" value="true" class="field-no_dd_validation"> <input type="hidden" name="meta_recurring" value="false" class="field-meta_recurring"> <input type="hidden" name="es_message" value="" class="field-es_message"> <input
type="hidden" name="amount" value="5000" class="field-amount"> <input type="hidden" name="css_url" value="" class="field-css_url"> <input type="hidden" name="return_parameters" value="true" class="field-return_parameters"> <input type="hidden"
name="stored_rnw_product_name" value="lema" class="field-stored_rnw_product_name"> <input type="hidden" name="stored_rnw_product_version" value="1.25.0" class="field-stored_rnw_product_version"> <input type="hidden" name="stored_rnw_source_url"
value="https://www.coralive.org/en/donation" class="field-stored_rnw_source_url"> <input type="hidden" name="stored_campaign_id" value="" class="field-stored_campaign_id"> <input type="hidden" name="stored_campaign_subid" value=""
class="field-stored_campaign_subid"> <input type="hidden" name="subscription_token" class="field-subscription_token"> <input type="hidden" name="stored_rnw_purpose_text" class="field-stored_rnw_purpose_text" value=""> <input type="hidden"
name="stored_rnw_hide_address_fields" value="false" class="field-stored_rnw_hide_address_fields"> <input type="hidden" name="stored_translated_recurring_interval" class="field-stored_translated_recurring_interval" value=""> <input type="hidden"
name="sid" value="488" class="field-sid"> <input type="hidden" name="keyword" value="GETUDEV" class="field-keyword">
<div>
<div class="lema-step lema-step-amount lema-shown">
<div class="lema-step-header"> <span class="lema-step-header-text">Amount</span>
<div class="lema-step-number"><span class="lema-step-number-text">1</span></div>
</div>
<div class="lema-step-content">
<div class="lema-step-row" data-block-id="recurring_interval_selector"> <input type="radio" class="getunik-radio rnw-ignore field-donation-type" name="donation-type" id="coral-2277-default-donation-type-1" value="onetime"> <label
class="lema-radio-label getunik-radio-label" for="coral-2277-default-donation-type-1"> One-off </label> <input type="radio" class="getunik-radio rnw-ignore field-donation-type" name="donation-type" id="coral-2277-default-donation-type-2"
value="recurring"> <label class="lema-radio-label lema-radio-label-interval getunik-radio-label" for="coral-2277-default-donation-type-2"> <label style="margin-left:0px;"
class="lema-radio-label lema-radio-label-interval getunik-radio-label" for="coral-2277-default-donation-type-2">
<div class="select2-container lema-select2-replace lema-select2-replace-interval field-interval-selector" id="s2id_autogen1">
<a href="javascript:void(0)" onclick="return false;" class="select2-choice" tabindex="-1"> <span>Regular</span><abbr class="select2-search-choice-close"></abbr> <div><b></b></div></a><input
class="select2-focusser select2-offscreen" type="text" id="s2id_autogen2">
<div class="select2-drop select2-display-none">
<div class="select2-search select2-search-hidden select2-offscreen"> <input type="text" autocomplete="off" autocorrect="off" autocapitilize="off" spellcheck="false" class="select2-input"> </div>
<ul class="select2-results"> </ul>
</div>
</div><select name="interval-selector" class="lema-select2-replace lema-select2-replace-interval field-interval-selector select2-offscreen" tabindex="-1">
<option data-interval-name="default" value="">Regular</option>
<option data-interval-name="weekly" value="* * 1">weekly</option>
<option data-interval-name="monthly" value="6 * *">monthly</option>
<option data-interval-name="quarterly" value="6 2,5,8,11 *">quarterly</option>
<option data-interval-name="semestral" value="6 2,8 *">half-yearly</option>
<option data-interval-name="yearly" value="6 2 *">annually</option>
</select>
</label> </label> </div>
<div class="lema-step-row lema-step-row-amounts">
<div data-block-id="amount-container" data-template="ich_field_amount" data-name="amounts">
<div class="lema-amount-box lema-active"> <input type="radio" class="rnw-ignore lema-hidden field-predefined-amount" name="predefined-amount" id="coral-2277-default-amount-0" value="5000"> <span class="lema-amount-box-currency">CHF</span>
<span class="lema-amount-box-amount">50</span> </div>
<div class="lema-amount-box"> <input type="radio" class="rnw-ignore lema-hidden field-predefined-amount" name="predefined-amount" id="coral-2277-default-amount-1" value="10000"> <span class="lema-amount-box-currency">CHF</span> <span
class="lema-amount-box-amount">100</span> </div>
<div class="lema-amount-box"> <input type="radio" class="rnw-ignore lema-hidden field-predefined-amount" name="predefined-amount" id="coral-2277-default-amount-2" value="20000"> <span class="lema-amount-box-currency">CHF</span> <span
class="lema-amount-box-amount">200</span> </div>
<div class="lema-amount-box"> <input type="radio" class="rnw-ignore lema-hidden field-predefined-amount" name="predefined-amount" id="coral-2277-default-amount-3" value="50000"> <span class="lema-amount-box-currency">CHF</span> <span
class="lema-amount-box-amount">500</span> </div>
</div>
<div data-block-id="custom-amount-container" data-template="ich_field_custom_amount" data-name="custom-amount">
<div class="lema-amount-box lema-amount-box-custom"> <input type="radio" class="rnw-ignore lema-hidden field-predefined-amount" name="predefined-amount" id="coral-2277-default-amount-custom-selector" value=""> <input type="text"
class="lema-input-text lema-input-text-small lema-amount-box-custom-input rnw-ignore field-customamount" name="customamount" id="coral-2277-default-amount-custom" value=""> <span class="lema-amount-box-currency">CHF</span> <span
class="lema-amount-box-amount">....</span> </div>
</div>
</div>
</div><!-- /.lema-step-content -->
</div><!-- /.lema-step -->
</div>
<div>
<div class="lema-step lema-step-payment-method lema-shown">
<div class="lema-step-header"> <span class="lema-step-header-text">Type of payment</span>
<div class="lema-step-number"><span class="lema-step-number-text">2</span></div>
</div>
<div class="lema-step-content">
<div class="lema-step-row">
<div class="lema-accordion-container" data-name="payment_method">
<div class="lema-choose-payment-method">Choose payment method</div>
<div class="lema-accordion-item accordion-open">
<div class="lema-accordion-header" data-target="#coral-2277-default-payment_accordion_item_cc">
<div class="lema-accordion-item-title"> Credit Card </div><!-- /.-accordion-item-title -->
<div class="lema-accordion-item-icons">
<div data-card-type="vis" class="lema-cc-icon lema-cc-icon-visa"></div>
<div data-card-type="cb" class="lema-cc-icon lema-hidden lema-cc-icon-cb"></div>
<div data-card-type="amx" class="lema-cc-icon lema-cc-icon-amx"></div>
<div data-card-type="eca" class="lema-cc-icon lema-cc-icon-master"></div>
<div data-card-type="din" class="lema-cc-icon lema-hidden lema-cc-icon-diners"></div>
<div data-card-type="jcb" class="lema-cc-icon lema-hidden lema-cc-icon-jcb"></div>
</div><!-- /.-accordion-item-icons -->
</div><!-- /.-accordion-header -->
<div id="coral-2277-default-payment_accordion_item_cc" data-meta-method="cc" class="lema-payment-item lema-payment-accordion-item lema-accordion-content lema-hidden" style="display: block;">
<div class="lema-step-row lema-card-icons lema-step-row-cc-icons">
<div data-card-type="vis" class="lema-cc-icon lema-cc-icon-visa"></div>
<div data-card-type="cb" class="lema-cc-icon lema-hidden lema-cc-icon-cb"></div>
<div data-card-type="amx" class="lema-cc-icon lema-cc-icon-amx"></div>
<div data-card-type="eca" class="lema-cc-icon lema-cc-icon-master"></div>
<div data-card-type="din" class="lema-cc-icon lema-hidden lema-cc-icon-diners"></div>
<div data-card-type="jcb" class="lema-cc-icon lema-hidden lema-cc-icon-jcb"></div>
</div>
<div id="lema-cardno-container" class="lema-step-row"> <input id="coral-2277-default-cardno" type="text" class="lema-input-text field-cardno" name="cardno" placeholder="Card Number"> </div>
<div class="lema-step-row lema-step-row-input-right">
<div class="lema-expire-wrapper">
<div class="lema-pseudo-label">Date of expiry:</div> <input type="text" class="lema-input-text lema-input-text-small field-expm" id="coral-2277-default-expm" name="expm" placeholder="MM"> <input type="text"
class="lema-input-text lema-input-text-small field-expy" id="coral-2277-default-expy" name="expy" placeholder="YY">
</div>
<div class="lema-cvc-wrapper">
<div class="lema-pseudo-label">CVV:</div>
<div class="lema-cvc-popup"> <a href="#" tabindex="-1" class="lema-info-icon lema-popup-open"></a>
<div class="lema-popup"> <a href="" class="lema-popup-close"></a>
<div class="lema-popup-content">
<p>These are the last 3 digits on the signature strip on the back of your card. </p>
</div>
<div class="lema-popup-edge"></div>
</div>
</div> <input type="text" class="lema-input-text lema-input-text-small field-cvv" id="coral-2277-default-cvv" name="cvv" placeholder="">
</div>
</div>
<div class="lema-step-row"> <a href="#" tabindex="-1" class="lema-info-icon lema-popup-open">Note on paying by credit card</a>
<div class="lema-popup"> <a href="" class="lema-popup-close"></a>
<div class="lema-popup-content"> <strong>Security:</strong><br>All information exchanged during credit card donations is SSL-encrypted. This data can neither be detected, intercepted nor used by third parties. Information is also
not stored in our data systems. <br><br><strong>Note:</strong><br> The donation will be accepted by the organisation FairGive and then passed directly to Coralive.org in a safe and trustworthy manner. <div
class="lema-popup-images"> <img src="https://lema.raisenow.com/widgets/lema/_default/img/visa_verified.png"> <img src="https://lema.raisenow.com/widgets/lema/_default/img/mastercard_secure.png"> </div>
</div>
<div class="lema-popup-edge"></div>
</div>
</div>
</div>
</div><!-- /.-accordion-item -->
<div class="lema-accordion-item">
<div class="lema-accordion-header" data-target="#coral-2277-default-payment_accordion_item_pf">
<div class="lema-accordion-item-title"> PostFinance </div><!-- /.-accordion-item-title -->
<div class="lema-accordion-item-icons">
<div class="lema-pm-icon lema-pm-icon-pfc"></div>
<div class="lema-pm-icon lema-pm-icon-pef"></div>
</div><!-- /.-accordion-item-icons -->
</div><!-- /.-accordion-header -->
<div id="coral-2277-default-payment_accordion_item_pf" data-meta-method="pf" class="lema-payment-item lema-payment-accordion-item lema-accordion-content lema-hidden" style="display: none;">
<div class="lema-step-row lema-line-light-bottom" data-payment-method="pfc">
<div data-card-type="pfc" class="lema-pf-icon lema-pf-icon-pfc"></div> <input type="radio" class="lema-amount rnw-ignore getunik-radio field-postfinance_sub" name="postfinance_sub" value="pfc"
id="coral-2277-default-postfinance_card" checked="checked"> <label for="coral-2277-default-postfinance_card" class="lema-radio-label getunik-radio-label"> PostFinance Card </label>
</div>
<div class="lema-step-row lema-line-light-bottom" data-payment-method="pef">
<div data-card-type="pef" class="lema-pf-icon lema-pf-icon-pef"></div> <input type="radio" class="lema-amount rnw-ignore getunik-radio field-postfinance_sub" name="postfinance_sub" value="pef"
id="coral-2277-default-postfinance_efinance"> <label for="coral-2277-default-postfinance_efinance" class="lema-radio-label getunik-radio-label"> PostFinance E-Finance </label>
</div>
<div class="lema-step-row"> <a href="" class="lema-info-icon lema-popup-open">Note on paying by PostFinance</a>
<div class="lema-popup"> <a href="" class="lema-popup-close"></a>
<div class="lema-popup-content"> Once you have completed and submitted this form, you will be redirected to PostFinance in order to complete your donation. <br><br><strong>Note:</strong><br> The donation will be accepted by the
organisation FairGive and then passed directly to Coralive.org in a safe and trustworthy manner. </div>
<div class="lema-popup-edge"></div>
</div>
</div>
</div>
</div><!-- /.-accordion-item -->
<div class="lema-accordion-item">
<div class="lema-accordion-header" data-target="#coral-2277-default-payment_accordion_item_pp">
<div class="lema-accordion-item-title"> PayPal </div><!-- /.-accordion-item-title -->
<div class="lema-accordion-item-icons">
<div class="lema-pm-icon lema-pm-icon-pp"></div>
</div><!-- /.-accordion-item-icons -->
</div><!-- /.-accordion-header -->
<div id="coral-2277-default-payment_accordion_item_pp" data-meta-method="pp" class="lema-payment-item lema-payment-accordion-item lema-accordion-content lema-hidden" style="display: none;">
<div class="lema-step-row lema-step-row-text">
<p>Once you have completed and submitted this form, you will be redirected to PayPal to confirm your donation.</p>
</div>
</div>
</div><!-- /.-accordion-item -->
</div>
</div>
</div><!-- /.lema-step-content -->
</div><!-- /.lema-step -->
</div>
<div>
<div class="lema-step lema-step-customer-identity lema-shown">
<div class="lema-step-header"> <span class="lema-step-header-text">Your personal data</span>
<div class="lema-step-number"><span class="lema-step-number-text">3</span></div>
</div>
<div class="lema-step-content">
<div class="lema-step-row" data-block-id="customer_salutation"> <input type="radio" class="getunik-radio field-stored_customer_salutation" name="stored_customer_salutation" id="coral-2277-default-stored_customer_salutation_ms" value="ms">
<label class="lema-radio-label getunik-radio-label" for="coral-2277-default-stored_customer_salutation_ms"> Ms. </label> <input type="radio" class="getunik-radio field-stored_customer_salutation" name="stored_customer_salutation"
id="coral-2277-default-stored_customer_salutation_mr" value="mr"> <label class="lema-radio-label getunik-radio-label" for="coral-2277-default-stored_customer_salutation_mr"> Mr. </label> </div>
<div class="lema-step-row" data-block-id="customer_firstname"> <input type="text" id="coral-2277-default-stored_customer_firstname" class="lema-input-text field-stored_customer_firstname" name="stored_customer_firstname"
placeholder="First name"> </div>
<div class="lema-step-row" data-block-id="customer_lastname"> <input type="text" id="coral-2277-default-stored_customer_lastname" class="lema-input-text field-stored_customer_lastname" name="stored_customer_lastname" placeholder="Last Name">
</div>
<div class="lema-step-row lema-step-row-input-right lema-hidden" data-field-type="tripledate" data-name="stored_customer_birthdate" data-block-id="customer_birthdate">
<div class="lema-pseudo-label lema-pseudo-label-birthday">Date of birth</div> <input type="text" class="lema-input-text lema-input-text-small lema-input-text-birthday lema-day rnw-ignore field-customer_birthdate_day"
name="customer_birthdate_day" placeholder="DD"> <input type="text" class="lema-input-text lema-input-text-small lema-input-text-birthday lema-month rnw-ignore field-customer_birthdate_month" name="customer_birthdate_month"
placeholder="MM"> <input type="text" class="lema-input-text lema-input-text-small lema-input-text-birthday lema-year rnw-ignore field-customer_birthdate_year" name="customer_birthdate_year" placeholder="YYYY">
</div>
<div class="lema-step-row" data-block-id="customer_email"> <input type="text" id="coral-2277-default-stored_customer_email" class="lema-input-text field-stored_customer_email" name="stored_customer_email" placeholder="E-Mail"> </div>
<div class="lema-step-row" data-block-id="customer_permission"> <input type="checkbox" name="stored_customer_email_permission" id="coral-2277-default-stored_customer_email_permission"
class="lema-checkbox getunik-checkbox single-checkbox field-stored_customer_email_permission" value="true"> <label for="coral-2277-default-stored_customer_email_permission" class="lema-checkbox-label getunik-checkbox-label">
<p>I would like to be informed about other projects</p>
</label> </div>
<div class="lema-step-row" data-block-id="customer_message"> <textarea name="stored_customer_message" class="lema-input-textarea field-stored_customer_message" rows="3" placeholder="Remarks"></textarea> </div>
<div class="lema-step-row" data-block-id="customer_receipt"> <input type="checkbox" name="stored_customer_donation_receipt" id="coral-2277-default-stored_customer_donation_receipt"
class="lema-checkbox getunik-checkbox single-checkbox field-stored_customer_donation_receipt" value="true"> <label for="coral-2277-default-stored_customer_donation_receipt" class="lema-checkbox-label getunik-checkbox-label">
<p>Yes, I want a donation receipt for tax returns</p>
</label> </div>
</div><!-- /.lema-step-content -->
</div><!-- /.lema-step -->
</div>
<div>
<div class="lema-step lema-step-customer-address lema-shown">
<div class="lema-step-header"> <span class="lema-step-header-text">Your address</span>
<div class="lema-step-number"><span class="lema-step-number-text">4</span></div>
</div>
<div class="lema-step-content">
<div class="lema-step-row lema-shown" data-block-id="customer_company"> <input type="text" id="coral-2277-default-stored_customer_company" class="lema-input-text field-stored_customer_company" name="stored_customer_company"
placeholder="Company (optional)"> </div>
<div class="lema-step-row" data-block-id="customer_street">
<div class="lema-clearfix"> <input type="text" id="coral-2277-default-stored_customer_street" class="lema-input-text field-stored_customer_street" name="stored_customer_street" placeholder="Street" style="width: 74%; float: left;"> <input
type="text" id="coral-2277-default-stored_customer_street_number" class="lema-input-text field-stored_customer_street_number" name="stored_customer_street_number" placeholder="No." style="width: 24%; float: right;"> </div>
</div>
<div class="lema-step-row lema-hidden" data-block-id="customer_street2"> <input type="text" id="coral-2277-default-stored_customer_street2" class="lema-input-text field-stored_customer_street2" name="stored_customer_street2"
placeholder="Additional street information"> </div>
<div class="lema-step-row lema-shown" data-block-id="customer_pobox"> <input type="text" id="coral-2277-default-stored_customer_pobox" class="lema-input-text field-stored_customer_pobox" name="stored_customer_pobox" placeholder="P.O.Box">
</div>
<div class="lema-step-row" data-block-id="customer_city">
<div class="lema-clearfix"> <input type="text" id="coral-2277-default-stored_customer_zip_code" class="lema-input-text field-stored_customer_zip_code" name="stored_customer_zip_code" placeholder="Postcode" style="width: 24%; float: left;">
<input type="text" id="coral-2277-default-stored_customer_city" class="lema-input-text field-stored_customer_city" name="stored_customer_city" placeholder="Town/City" style="width: 74%; float: right;"> </div>
</div>
<div class="lema-step-row" data-block-id="customer_country">
<div class="select2-container lema-select2-replace-search field-stored_customer_country" id="s2id_coral-2277-default-stored_customer_country">
<a href="javascript:void(0)" onclick="return false;" class="select2-choice" tabindex="-1"> <span>Switzerland</span><abbr class="select2-search-choice-close"></abbr> <div><b></b></div></a><input
class="select2-focusser select2-offscreen" type="text" id="s2id_autogen3" tabindex="-1">
<div class="select2-drop select2-display-none">
<div class="select2-search select2-search-hidden select2-offscreen"> <input type="text" autocomplete="off" autocorrect="off" autocapitilize="off" spellcheck="false" class="select2-input"> </div>
<ul class="select2-results"> </ul>
</div>
</div><select id="coral-2277-default-stored_customer_country" name="stored_customer_country" class="lema-select2-replace-search field-stored_customer_country select2-offscreen" tabindex="-1">
<option value="CH">Switzerland</option>
<option value="DE">Germany</option>
<option value="FR">France</option>
<option value="IT">Italy</option>
<option value="AF">Afghanistan</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="BN">Brunei Darussalam</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="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="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="CI">Côte dIvoire</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="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="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Lands</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</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="GU">Guam</option>
<option value="GT">Guatemala</option>
<option value="GG">Guernsey</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard and McDonald Islands</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran</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="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JE">Jersey</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KP">Korea, North</option>
<option value="KR">Korea, South</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">Macau</option>
<option value="MK">Macedonia</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="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia</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</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="AN">Netherlands Antilles</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="MP">Northern Mariana Islands</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestine</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="RE">Reunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="SH">Saint Helena</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="PM">Saint Pierre and Miquelon</option>
<option value="VC">Saint Vincent and the Grenadines</option>
<option value="BL">Saint-Barthélemy</option>
<option value="MF">Saint-Martin (French part)</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="GS">South Georgia and South Sandwich Islands</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard and Jan Mayen Islands</option>
<option value="SZ">Swaziland</option>
<option value="SE">Sweden</option>
<option value="SY">Syria</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 and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="US">United States of America</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="VG">Virgin Islands, British</option>
<option value="VI">Virgin Islands, U.S.</option>
<option value="WF">Wallis and Futuna Islands</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
<option value="AX">Åland</option>
</select>
</div>
</div><!-- /.lema-step-content -->
</div><!-- /.lema-step -->
</div>
<div>
<div class="lema-step lema-step-customer-address-compact-mode lema-hidden">
<div class="lema-step-header"> <span class="lema-step-header-text">Your data</span>
<div class="lema-step-number"><span class="lema-step-number-text">5</span></div>
</div>
<div class="lema-step-content">
<div class="lema-customer-compact-mode">
<div class="lema-step-row clearfix">
<div class="lema-step-row-left"> <label class="lema-label-standalone">Your personal data</label> </div><!-- /.-step-row-left -->
<div class="lema-step-row-right" id="coral-2277-default-compact-mode-customer-identity"> </div><!-- /.-step-row-right -->
</div><!-- /.-step-row -->
<div class="lema-step-row clearfix">
<div class="lema-step-row-left"> <label class="lema-label-standalone">Your e-mail address</label> </div><!-- /.-step-row-left -->
<div class="lema-step-row-right" id="coral-2277-default-compact-mode-customer-email"> </div><!-- /.-step-row-right -->
</div><!-- /.-step-row -->
<div class="lema-step-row clearfix">
<div class="lema-step-row-left"> <label class="lema-label-standalone">Birth date</label> </div><!-- /.-step-row-left -->
<div class="lema-step-row-right" id="coral-2277-default-compact-mode-customer-birthdate"> </div><!-- /.-step-row-right -->
</div><!-- /.-step-row -->
<div class="lema-step-row clearfix">
<div class="lema-step-row-left"> <label class="lema-label-standalone">Adresse</label> </div><!-- /.-step-row-left -->
<div class="lema-step-row-right" id="coral-2277-default-compact-mode-customer-address"> </div><!-- /.-step-row-right -->
</div><!-- /.-step-row -->
<hr>
<div class="lema-step-row clearfix"> <a class="lema-link lema-link-left lema-change-address-link" href="#">change my personal data</a> <a class="lema-link lema-link-right lema-not-me-link" href="#">This isn't me</a> </div>
<!-- /.-step-row -->
</div><!-- /.lema-customer-compact-mode -->
</div><!-- /.lema-step-content -->
</div><!-- /.lema-step -->
</div> <input type="hidden" name="stored_rnw_widget_uuid" value="coral-2277"><input type="hidden" name="stored_rnw_widget_instance_id" value="coral-2277-default">
</form>Text Content
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