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donate.filmforum.org Open in urlscan Pro
52.41.214.177  Public Scan

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Submitted URL: http://donate.filmforum.org/
Effective URL: https://donate.filmforum.org/give/
Submission: On January 05 via api from JP — Scanned from JP

Form analysis 1 forms found in the DOM

<form id="donate-form"><input name="__RequestVerificationToken" type="hidden" value="CfDJ8NvUv_C173VHsq9gHVOZn4DsGBCBDXqpUA9kiHFKNWgSiIHPMMLrWbag5knunimYwNqEb7YllzcEMbnLJCHT4NLrO0QmucvM77Uqqel0A2l6lp9EDZseaCvhSwqrt4Ng1hqLIaNNVrlPg8mojCWi8PU">
  <h3 class="header">Select a Donation Amount</h3>
  <div role="group" aria-label="Suggested donation amount" class="btn-group-lg mb-3 text-center"><input type="radio" name="btnDonationAmount" id="donationAmount0" value="0" class="btn-check form-check-input"> <label for="donationAmount0"
      class="btn btn-outline-dark m-2">$50</label> <input type="radio" name="btnDonationAmount" id="donationAmount1" value="1" class="btn-check form-check-input"> <label for="donationAmount1" class="btn btn-outline-dark m-2">$100</label> <input
      type="radio" name="btnDonationAmount" id="donationAmount2" value="2" class="btn-check form-check-input"> <label for="donationAmount2" class="btn btn-outline-dark m-2">$250</label> <input type="radio" name="btnDonationAmount"
      id="donationAmount3" value="3" class="btn-check form-check-input"> <label for="donationAmount3" class="btn btn-outline-dark m-2">$500</label> <input type="radio" name="btnDonationAmount" id="donationAmount4" value="4"
      class="btn-check form-check-input"> <label for="donationAmount4" class="btn btn-outline-dark m-2">$1000</label> <input type="radio" name="btnDonationAmount" id="donationAmountOther" value="5" class="btn-check form-check-input"> <label
      for="donationAmountOther" class="btn btn-outline-dark m-2">Other</label></div>
  <div class="mb-3 form-floating"><input type="number" min="5" name="amount" id="amount" placeholder="Amount" class="form-control"></div> <!---->
  <div><input type="hidden" name="fundId" value="15"></div>
  <div class="form-check"><input type="checkbox" value="0" name="PaymentOptions" id="recurringGift" class="form-check-input"> <label for="recurringGift" class="form-check-label"> Recurring Gift </label></div> <!---->
  <div class="mt-3">
    <div class="form-check"><input type="checkbox" value="" id="addFees" class="form-check-input"> <label for="addFees" class="form-check-label"> I would like to cover the credit card transaction fee (2.5%). <span> Add $1.25 to my
          total.</span></label> <input type="hidden" name="fee" value="0">
      <div class="fw-bold fs-5 submit-total">Total payment today: $50.00</div>
    </div>
  </div>
  <h3 class="header">In Honor/Memory Of</h3>
  <div class="mb-1 mt-3 form-floating">
    <div class="form-check"><input type="checkbox" value="" id="honorMemoryOption" class="form-check-input"> <label for="honorMemoryOption" class="form-check-label mb-1"> This gift is in honor / memory of... </label></div>
  </div> <!---->
  <h3 class="header">Matching Gift</h3>
  <div class="mb-3 form-floating">
    <div class="form-check"><input type="checkbox" value="" id="matchingGiftOption" class="form-check-input"> <label for="matchingGiftOption" class="form-check-label"> My employer will match this gift </label></div>
  </div> <!---->
  <h3 class="header">Contact Information</h3>
  <div class="mb-3 form-floating"><input type="text" name="firstName" id="firstName" placeholder="First Name" class="form-control"> <label for="firstName" class="form-label">First Name</label></div>
  <div class="mb-3 form-floating"><input type="text" name="lastName" id="lastName" placeholder="Last Name" class="form-control"> <label for="lastName" class="form-label">Last Name</label></div>
  <div class="mb-3 form-floating"><input type="text" name="address" id="address" placeholder="Address" class="form-control"> <label for="address" class="form-label">Address</label></div>
  <div class="mb-3 form-floating"><input type="text" name="city" id="city" placeholder="City" class="form-control"> <label for="city" class="form-label">City</label></div>
  <div class="mb-3 form-floating"><select id="state" name="stateCode" aria-label="State" class="form-select mb-3">
      <option value="AL">Alabama</option>
      <option value="AK">Alaska</option>
      <option value="AA">American Embassy</option>
      <option value="AE">American Embassy</option>
      <option value="AS">American Samoa</option>
      <option value="AZ">Arizona</option>
      <option value="AR">Arkansas</option>
      <option value="AP">Armed Forces</option>
      <option value="CA">California</option>
      <option value="CO">Colorado</option>
      <option value="CT">Connecticut</option>
      <option value="DC">D.C.</option>
      <option value="DE">Delaware</option>
      <option value="FL">Florida</option>
      <option value="GA">Georgia</option>
      <option value="GU">Guam</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="MH">Marshall Islands</option>
      <option value="MD">Maryland</option>
      <option value="MA">Massachusetts</option>
      <option value="MI">Michigan</option>
      <option value="FM">Micronesia</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="CM">Northern Mariana Is.</option>
      <option value="OH">Ohio</option>
      <option value="OK">Oklahoma</option>
      <option value="OR">Oregon</option>
      <option value="PW">Palau</option>
      <option value="PA">Pennsylvania</option>
      <option value="PR">Puerto Rico</option>
      <option value="RI">Rhode Island</option>
      <option value="SC">South Carolina</option>
      <option value="SD">South Dakota</option>
      <option value="TN">Tennessee</option>
      <option value="TX">Texas</option>
      <option value="TT">Trust Territories</option>
      <option value="XX">Unknown</option>
      <option value="UT">Utah</option>
      <option value="VT">Vermont</option>
      <option value="VI">Virgin Islands</option>
      <option value="VA">Virginia</option>
      <option value="WA">Washington</option>
      <option value="WV">West Virginia</option>
      <option value="WI">Wisconsin</option>
      <option value="WY">Wyoming</option>
    </select> <label for="state" class="form-label">State</label></div>
  <div class="mb-3 form-floating"><select id="country" name="countryId" class="form-select mb-3">
      <option value="231"></option>
      <option value="226">Afghanistan</option>
      <option value="3">Albania</option>
      <option value="4">Algeria</option>
      <option value="5">Andorra</option>
      <option value="6">Angola</option>
      <option value="10">Antigua and Barbuda</option>
      <option value="7">Argentina</option>
      <option value="235">Armenia</option>
      <option value="8">Aruba</option>
      <option value="227">Australia</option>
      <option value="11">Austria</option>
      <option value="12">Azores</option>
      <option value="230">Bahamas</option>
      <option value="18">Bahrain</option>
      <option value="24">Bangladesh</option>
      <option value="219">Barbados</option>
      <option value="236">Belarus</option>
      <option value="15">Belgium</option>
      <option value="22">Belize</option>
      <option value="16">Benin</option>
      <option value="17">Bermuda</option>
      <option value="19">Bhutan</option>
      <option value="25">Bolivia</option>
      <option value="237">Bosnia and Herzegovina</option>
      <option value="26">Botswana</option>
      <option value="27">Brazil</option>
      <option value="202">British Virgin Islnd</option>
      <option value="28">Brunei Darussalam</option>
      <option value="29">Bulgaria</option>
      <option value="21">Burkina Faso</option>
      <option value="30">Burma</option>
      <option value="23">Burundi</option>
      <option value="238">Cambodia</option>
      <option value="31">Cameroon</option>
      <option value="32">Canada</option>
      <option value="42">Canal Zone</option>
      <option value="41">Canary Islands</option>
      <option value="46">Cape Verde</option>
      <option value="49">Cayman Islands</option>
      <option value="33">Central African Rep</option>
      <option value="36">Chad</option>
      <option value="35">Channel Islands</option>
      <option value="37">Chile</option>
      <option value="239">China</option>
      <option value="43">Colombia</option>
      <option value="40">Comoros</option>
      <option value="171">Confed of Senegambia</option>
      <option value="44">Congo</option>
      <option value="39">Cook Islands</option>
      <option value="45">Costa Rica</option>
      <option value="232">Croatia</option>
      <option value="47">Cuba</option>
      <option value="48">Curacao</option>
      <option value="50">Cyprus</option>
      <option value="240">Czech Republic</option>
      <option value="51">Czechoslovakia</option>
      <option value="52">Dahomey</option>
      <option value="53">Denmark</option>
      <option value="54">Djibouti</option>
      <option value="145">Dm People's Rp Korea</option>
      <option value="55">Dominica</option>
      <option value="56">Dominican Republic</option>
      <option value="241">East Timor</option>
      <option value="57">Ecuador</option>
      <option value="58">Egypt</option>
      <option value="59">El Salvador</option>
      <option value="60">England</option>
      <option value="61">Equatorial Guinea</option>
      <option value="242">Eritrea</option>
      <option value="62">Estonia</option>
      <option value="63">Ethiopia</option>
      <option value="64">Faeroe Islands</option>
      <option value="67">Falkland Islands</option>
      <option value="69">Fed Rep of Germany</option>
      <option value="243">Federated States of Micronesia</option>
      <option value="66">Fiji</option>
      <option value="65">Finland</option>
      <option value="68">France</option>
      <option value="34">French Guiana</option>
      <option value="70">French Polynesia</option>
      <option value="71">Gabon</option>
      <option value="244">Georgia</option>
      <option value="74">Germany</option>
      <option value="75">Ghana</option>
      <option value="76">Gibraltar</option>
      <option value="77">Gilbert &amp; Ellice Is</option>
      <option value="79">Greece</option>
      <option value="80">Greenland</option>
      <option value="73">Grenada</option>
      <option value="81">Guadaloupe</option>
      <option value="78">Guatemala</option>
      <option value="83">Guinea</option>
      <option value="82">Guinea-Bissau</option>
      <option value="84">Guyana</option>
      <option value="85">Haiti</option>
      <option value="88">Honduras</option>
      <option value="86">Hong Kong</option>
      <option value="89">Hungary</option>
      <option value="90">Iceland</option>
      <option value="92">India</option>
      <option value="91">Indonesia</option>
      <option value="95">Iran</option>
      <option value="96">Iraq</option>
      <option value="94">Ireland</option>
      <option value="97">Isle Of Man</option>
      <option value="98">Israel</option>
      <option value="99">Italy</option>
      <option value="100">Ivory Coast</option>
      <option value="101">Jamaica</option>
      <option value="102">Japan</option>
      <option value="103">Jordan</option>
      <option value="105">Kampuchea</option>
      <option value="245">Kazakhstan</option>
      <option value="106">Kenya</option>
      <option value="108">Kiribati</option>
      <option value="246">Kosovo</option>
      <option value="109">Kuwait</option>
      <option value="247">Kyrgyzstan</option>
      <option value="110">Laos</option>
      <option value="111">Latvia</option>
      <option value="112">Lebanon</option>
      <option value="113">Lesotho</option>
      <option value="114">Liberia</option>
      <option value="118">Libya</option>
      <option value="115">Liechtenstein</option>
      <option value="116">Lithuania</option>
      <option value="117">Luxembourg</option>
      <option value="119">Macau</option>
      <option value="248">Macedonia</option>
      <option value="120">Madagascar</option>
      <option value="127">Malawi</option>
      <option value="121">Malaysia</option>
      <option value="249">Maldives</option>
      <option value="126">Mali</option>
      <option value="133">Malta</option>
      <option value="250">Marshall Islands</option>
      <option value="122">Martinique</option>
      <option value="123">Mauritania</option>
      <option value="134">Mauritius</option>
      <option value="125">Mexico</option>
      <option value="251">Moldova</option>
      <option value="130">Monaco</option>
      <option value="129">Mongolia</option>
      <option value="252">Montenegro</option>
      <option value="128">Montserrat Island</option>
      <option value="131">Morocco</option>
      <option value="132">Mozambique</option>
      <option value="253">Myanmar</option>
      <option value="135">Namibia</option>
      <option value="136">Nauru</option>
      <option value="138">Nepal</option>
      <option value="87">Netherlands</option>
      <option value="148">Netherlands Antilles</option>
      <option value="139">Nevis</option>
      <option value="137">New Caledonia</option>
      <option value="140">New Guinea</option>
      <option value="213">New Hebrides</option>
      <option value="149">New Zealand</option>
      <option value="141">Nicaragua</option>
      <option value="142">Niger</option>
      <option value="147">Nigeria</option>
      <option value="144">Niue</option>
      <option value="254">North Korea</option>
      <option value="143">Northern Ireland, UK</option>
      <option value="146">Norway</option>
      <option value="150">Okinawa</option>
      <option value="151">Oman</option>
      <option value="152">Pacific Islands</option>
      <option value="153">Pakistan</option>
      <option value="255">Palau</option>
      <option value="154">Panama</option>
      <option value="155">Papua New Guinea</option>
      <option value="156">Paraguay</option>
      <option value="222">People's Dm Rp Yemen</option>
      <option value="38">People's Rp of China</option>
      <option value="157">Peru</option>
      <option value="158">Philippines</option>
      <option value="159">Pitcairn</option>
      <option value="160">Poland</option>
      <option value="161">Portugal</option>
      <option value="20">Portuguese Guinea</option>
      <option value="162">Qatar</option>
      <option value="177">Republic of Korea</option>
      <option value="124">Republic of Maldives</option>
      <option value="256">Republic of the Congo</option>
      <option value="163">Reunion Islands</option>
      <option value="164">Romania</option>
      <option value="233">Russia</option>
      <option value="166">Rwanda</option>
      <option value="167">Ryukyu Islands</option>
      <option value="185">Saint Lucia</option>
      <option value="257">Samoa</option>
      <option value="178">San Marino</option>
      <option value="168">Sao Tome &amp; Principe</option>
      <option value="169">Saudi Arabia</option>
      <option value="170">Scotland</option>
      <option value="172">Senegal</option>
      <option value="258">Serbia</option>
      <option value="173">Seychelles</option>
      <option value="174">Sierra Leone</option>
      <option value="175">Singapore</option>
      <option value="234">Slovakia</option>
      <option value="228">Slovenia</option>
      <option value="181">Solomon Islands</option>
      <option value="182">Somalia</option>
      <option value="180">South Africa</option>
      <option value="229">South Korea</option>
      <option value="259">South Sudan</option>
      <option value="183">Spain</option>
      <option value="184">Sri Lanka</option>
      <option value="186">St Martin</option>
      <option value="187">St Vincent &amp; Grenad</option>
      <option value="176">St. Kitts and Nevis</option>
      <option value="188">Sudan</option>
      <option value="189">Suriname</option>
      <option value="190">Swaziland</option>
      <option value="191">Sweden</option>
      <option value="192">Switzerland</option>
      <option value="193">Syria</option>
      <option value="194">Tahiti</option>
      <option value="195">Taiwan</option>
      <option value="260">Tajikistan</option>
      <option value="196">Tanzania</option>
      <option value="197">Thailand</option>
      <option value="13">The Bahamas</option>
      <option value="72">The Gambia</option>
      <option value="198">Tibet</option>
      <option value="199">Timor</option>
      <option value="200">Togo</option>
      <option value="201">Tonga</option>
      <option value="203">Trinidad &amp; Tobago</option>
      <option value="204">Tunisia</option>
      <option value="205">Turkey</option>
      <option value="261">Turkmenistan</option>
      <option value="206">Tuvalu</option>
      <option value="208">Uganda</option>
      <option value="262">Ukraine</option>
      <option value="207">United Arab Emirates</option>
      <option value="209">United Kingdom</option>
      <option value="210">Upper Volta</option>
      <option value="211">Uruguay</option>
      <option value="1">USA</option>
      <option value="263">Uzbekistan</option>
      <option value="215">Vanuatu</option>
      <option value="214">Vatican City</option>
      <option value="216">Venezuela</option>
      <option value="217">Vietnam</option>
      <option value="218">Wales</option>
      <option value="179">Western Samoa</option>
      <option value="220">Yemen Arab Republic</option>
      <option value="223">Yugoslavia</option>
      <option value="107">Zaire</option>
      <option value="224">Zambia</option>
      <option value="225">Zimbabwe</option>
    </select> <label for="country" class="form-label">Country</label></div>
  <div class="mb-3 form-floating"><input type="email" name="zip" id="zip" placeholder="Zip" class="form-control"> <label for="zip" class="form-label">Zip</label></div>
  <div class="mb-3 form-floating"><input type="email" name="email" id="emailAddress" placeholder="Email" class="form-control"> <label for="emailAddress" class="form-label">Email</label></div>
  <div class="mb-3 form-floating"><input type="text" name="phone" id="phone" placeholder="Phone" class="form-control"> <label for="phone" class="form-label">Phone</label></div>
  <div class="mb-1 mt-3 form-floating">
    <h6 class="fw-bold">RECOGNITION</h6>
    <div class="form-check"><input type="checkbox" value="0" name="recognitionOptionsValue" id="remainAnonymous" class="form-check-input"> <label for="remainAnonymous" class="form-check-label"> I would like to remain anonymous </label></div>
  </div>
  <h3 class="header">Payment Information</h3>
  <div class="mb-3 form-floating"><input type="text" name="creditCard.creditCardName" id="creditCardName" placeholder="Name on Card" class="form-control"> <label for="creditCardName" class="form-label">Name on Card</label></div>
  <div class="mb-3 form-floating"><select id="creditCardType" name="creditCard.creditCardType" class="form-select mb-3">
      <option value="93">Visa</option>
      <option value="94">Master Card</option>
      <option value="95">American Express</option>
      <option value="96">Discover</option>
    </select> <label for="creditCardTypeId" class="form-label">Credit Card Type</label></div>
  <div class="mb-3 form-floating"><input type="text" name="creditCard.creditCardNumber" id="creditCardNumber" placeholder="Credit Card Number" class="form-control"> <label for="creditCardNumber" class="form-label">Credit Card Number</label></div>
  <div class="mb-3 form-floating"><input type="text" name="creditCard.cvv" id="cvv" placeholder="CVV" class="form-control"> <label for="cvv" class="form-label">CVV</label></div>
  <div class="mb-3 form-floating"><select id="months" name="creditCard.creditCardExpiryMonth" class="form-select mb-3">
      <option value="1">January</option>
      <option value="2">February</option>
      <option value="3">March</option>
      <option value="4">April</option>
      <option value="5">May</option>
      <option value="6">June</option>
      <option value="7">July</option>
      <option value="8">August</option>
      <option value="9">September</option>
      <option value="10">October</option>
      <option value="11">November</option>
      <option value="12">December</option>
    </select> <label for="months" class="form-label">Expiration Month</label></div>
  <div class="mb-3 form-floating"><select id="years" name="creditCard.creditCardExpiryYear" class="form-select mb-3">
      <option value="2024">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>
    </select> <label for="years" class="form-label">Expiration Year</label></div> <!----> <input type="hidden" name="creditCard.creditCardRequired" value="true"> <input type="hidden" name="requireState" value="true">
  <div id="recaptcha-div" class="col-md-6 col-xs-12 mb-4 mt-3 mx-auto">
    <div data-sitekey="6LdQMdkjAAAAAP-s2NqfPsPUNHGTTv_5aGqy-6Fu" class="g-recaptcha text-center">
      <div style="width: 304px; height: 78px;">
        <div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-rnxqe9yxi9oi" frameborder="0" scrolling="no"
            sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation"
            src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6LdQMdkjAAAAAP-s2NqfPsPUNHGTTv_5aGqy-6Fu&amp;co=aHR0cHM6Ly9kb25hdGUuZmlsbWZvcnVtLm9yZzo0NDM.&amp;hl=en&amp;v=u-xcq3POCWFlCr3x8_IPxgPu&amp;size=normal&amp;cb=5em2q3ark89k"></iframe>
        </div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
          style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
      </div><iframe style="display: none;"></iframe>
    </div>
  </div>
  <div class="mx-auto text-center">
    <p class="fw-bold submit-total">Total payment today: $50.00</p> <button type="submit" class="button blue large">Donate Now</button>
  </div> <!----> <!---->
</form>

Text Content

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