enroll.everydaydisciplemakers.com
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https://enroll.everydaydisciplemakers.com/
Submission: On April 11 via api from US — Scanned from US
Submission: On April 11 via api from US — Scanned from US
Form analysis 1 forms found in the DOM
Name: paymentForm —
<form id="paymentForm" name="paymentForm" class="ng-pristine ng-invalid ng-invalid-required ng-valid-email ng-valid-maxlength" novalidate="novalidate">
<h3 class="mb-24 text-uppercase">Contact Information</h3>
<div class="border-bottom mb-16">
<div class="row mx-n8">
<div class="col-sm-6 col-12 px-8">
<div class="form-group d-flex flex-column">
<input type="text" class="form-control order-2 ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" autofill="" id="fname" name="fname" ng-model="order.customer.first_name" required="" spellcheck="false" value=""
autocomplete="given-name">
<label for="fname" class="order-1">First Name</label>
</div>
</div>
<div class="col-sm-6 col-12 px-8">
<div class="form-group d-flex flex-column">
<input type="text" class="form-control order-2 ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" autofill="" id="lname" name="lname" ng-model="order.customer.last_name" required="" spellcheck="false" value=""
autocomplete="family-name">
<label for="lname" class="order-1">Last Name</label>
</div>
</div>
</div>
<div class="form-group d-flex flex-column">
<input type="email" class="form-control order-2 ng-pristine ng-untouched ng-empty ng-valid-email ng-invalid ng-invalid-required" autofill="" id="email" name="email" ng-model="order.customer.email" required="" spellcheck="false" value=""
autocomplete="email">
<label for="email" class="order-1">Email Address</label>
</div>
<!-- ngIf: checkoutState.product.properties.phone_number_field -->
</div>
<h3 class="mb-24 text-uppercase">Billing Information</h3>
<div class="border-bottom mb-16">
<div class="form-group d-flex flex-column">
<input type="text" class="form-control order-2 ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" id="billing_address" name="billing_address" spellcheck="false" ng-model="order.billing_address.address" value="" autofill=""
required="">
<label for="billing_address" class="order-1">Address</label>
</div>
<div class="row mx-n8">
<div class="col-6 px-8">
<div class="form-group d-flex flex-column">
<input type="text" class="form-control order-2 ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" id="billing_city" name="billing_city" spellcheck="false" ng-model="order.billing_address.city" value="" autofill=""
required="">
<label for="billing_city" class="order-1">City</label>
</div>
</div>
<div class="col-6 px-8">
<div class="form-group d-flex flex-column">
<select class="form-control order-2 ng-pristine ng-untouched ng-valid ng-empty" id="billing_country" name="billing_country" ng-model="order.billing_address.country" ng-options="country.id as country.name for country in countries"
ng-change="billingCountrySelected(827597, false, false)" autofill="" autofill-type-hint="">
<option value="" class="" selected="selected">Country</option>
<option label="United States" value="number:840">United States</option>
<option label="Afghanistan" value="number:4">Afghanistan</option>
<option label="Åland Islands" value="number:248">Åland Islands</option>
<option label="Albania" value="number:8">Albania</option>
<option label="Algeria" value="number:12">Algeria</option>
<option label="American Samoa" value="number:16">American Samoa</option>
<option label="Andorra" value="number:20">Andorra</option>
<option label="Angola" value="number:24">Angola</option>
<option label="Anguilla" value="number:660">Anguilla</option>
<option label="Antarctica" value="number:10">Antarctica</option>
<option label="Antigua and Barbuda" value="number:28">Antigua and Barbuda</option>
<option label="Argentina" value="number:32">Argentina</option>
<option label="Armenia" value="number:51">Armenia</option>
<option label="Aruba" value="number:533">Aruba</option>
<option label="Australia" value="number:36">Australia</option>
<option label="Austria" value="number:40">Austria</option>
<option label="Azerbaijan" value="number:31">Azerbaijan</option>
<option label="Bahamas" value="number:44">Bahamas</option>
<option label="Bahrain" value="number:48">Bahrain</option>
<option label="Bangladesh" value="number:50">Bangladesh</option>
<option label="Barbados" value="number:52">Barbados</option>
<option label="Belarus" value="number:112">Belarus</option>
<option label="Belgium" value="number:56">Belgium</option>
<option label="Belize" value="number:84">Belize</option>
<option label="Benin" value="number:204">Benin</option>
<option label="Bermuda" value="number:60">Bermuda</option>
<option label="Bhutan" value="number:64">Bhutan</option>
<option label="Bolivia, Plurinational State of" value="number:68">Bolivia, Plurinational State of</option>
<option label="Bonaire, Sint Eustatius and Saba" value="number:535">Bonaire, Sint Eustatius and Saba</option>
<option label="Bosnia and Herzegovina" value="number:70">Bosnia and Herzegovina</option>
<option label="Botswana" value="number:72">Botswana</option>
<option label="Bouvet Island" value="number:74">Bouvet Island</option>
<option label="Brazil" value="number:76">Brazil</option>
<option label="British Indian Ocean Territory" value="number:86">British Indian Ocean Territory</option>
<option label="Brunei Darussalam" value="number:96">Brunei Darussalam</option>
<option label="Bulgaria" value="number:100">Bulgaria</option>
<option label="Burkina Faso" value="number:854">Burkina Faso</option>
<option label="Burundi" value="number:108">Burundi</option>
<option label="Cambodia" value="number:116">Cambodia</option>
<option label="Cameroon" value="number:120">Cameroon</option>
<option label="Canada" value="number:124">Canada</option>
<option label="Cape Verde" value="number:132">Cape Verde</option>
<option label="Cayman Islands" value="number:136">Cayman Islands</option>
<option label="Central African Republic" value="number:140">Central African Republic</option>
<option label="Chad" value="number:148">Chad</option>
<option label="Chile" value="number:152">Chile</option>
<option label="China" value="number:156">China</option>
<option label="Christmas Island" value="number:162">Christmas Island</option>
<option label="Cocos (Keeling) Islands" value="number:166">Cocos (Keeling) Islands</option>
<option label="Colombia" value="number:170">Colombia</option>
<option label="Comoros" value="number:174">Comoros</option>
<option label="Congo" value="number:178">Congo</option>
<option label="Congo, the Democratic Republic of the" value="number:180">Congo, the Democratic Republic of the</option>
<option label="Cook Islands" value="number:184">Cook Islands</option>
<option label="Costa Rica" value="number:188">Costa Rica</option>
<option label="Côte d'Ivoire" value="number:384">Côte d'Ivoire</option>
<option label="Croatia" value="number:191">Croatia</option>
<option label="Cuba" value="number:192">Cuba</option>
<option label="Curaçao" value="number:531">Curaçao</option>
<option label="Cyprus" value="number:196">Cyprus</option>
<option label="Czech Republic" value="number:203">Czech Republic</option>
<option label="Denmark" value="number:208">Denmark</option>
<option label="Djibouti" value="number:262">Djibouti</option>
<option label="Dominica" value="number:212">Dominica</option>
<option label="Dominican Republic" value="number:214">Dominican Republic</option>
<option label="Ecuador" value="number:218">Ecuador</option>
<option label="Egypt" value="number:818">Egypt</option>
<option label="El Salvador" value="number:222">El Salvador</option>
<option label="Equatorial Guinea" value="number:226">Equatorial Guinea</option>
<option label="Eritrea" value="number:232">Eritrea</option>
<option label="Estonia" value="number:233">Estonia</option>
<option label="Ethiopia" value="number:231">Ethiopia</option>
<option label="Falkland Islands (Malvinas)" value="number:238">Falkland Islands (Malvinas)</option>
<option label="Faroe Islands" value="number:234">Faroe Islands</option>
<option label="Fiji" value="number:242">Fiji</option>
<option label="Finland" value="number:246">Finland</option>
<option label="France" value="number:250">France</option>
<option label="French Guiana" value="number:254">French Guiana</option>
<option label="French Polynesia" value="number:258">French Polynesia</option>
<option label="French Southern Territories" value="number:260">French Southern Territories</option>
<option label="Gabon" value="number:266">Gabon</option>
<option label="Gambia" value="number:270">Gambia</option>
<option label="Georgia" value="number:268">Georgia</option>
<option label="Germany" value="number:276">Germany</option>
<option label="Ghana" value="number:288">Ghana</option>
<option label="Gibraltar" value="number:292">Gibraltar</option>
<option label="Greece" value="number:300">Greece</option>
<option label="Greenland" value="number:304">Greenland</option>
<option label="Grenada" value="number:308">Grenada</option>
<option label="Guadeloupe" value="number:312">Guadeloupe</option>
<option label="Guam" value="number:316">Guam</option>
<option label="Guatemala" value="number:320">Guatemala</option>
<option label="Guernsey" value="number:831">Guernsey</option>
<option label="Guinea" value="number:324">Guinea</option>
<option label="Guinea-Bissau" value="number:624">Guinea-Bissau</option>
<option label="Guyana" value="number:328">Guyana</option>
<option label="Haiti" value="number:332">Haiti</option>
<option label="Heard Island and McDonald Islands" value="number:334">Heard Island and McDonald Islands</option>
<option label="Holy See (Vatican City State)" value="number:336">Holy See (Vatican City State)</option>
<option label="Honduras" value="number:340">Honduras</option>
<option label="Hong Kong" value="number:344">Hong Kong</option>
<option label="Hungary" value="number:348">Hungary</option>
<option label="Iceland" value="number:352">Iceland</option>
<option label="India" value="number:356">India</option>
<option label="Indonesia" value="number:360">Indonesia</option>
<option label="Iran, Islamic Republic of" value="number:364">Iran, Islamic Republic of</option>
<option label="Iraq" value="number:368">Iraq</option>
<option label="Ireland" value="number:372">Ireland</option>
<option label="Isle of Man" value="number:833">Isle of Man</option>
<option label="Israel" value="number:376">Israel</option>
<option label="Italy" value="number:380">Italy</option>
<option label="Jamaica" value="number:388">Jamaica</option>
<option label="Japan" value="number:392">Japan</option>
<option label="Jersey" value="number:832">Jersey</option>
<option label="Jordan" value="number:400">Jordan</option>
<option label="Kazakhstan" value="number:398">Kazakhstan</option>
<option label="Kenya" value="number:404">Kenya</option>
<option label="Kiribati" value="number:296">Kiribati</option>
<option label="Korea, Democratic People's Republic of" value="number:408">Korea, Democratic People's Republic of</option>
<option label="Korea, Republic of" value="number:410">Korea, Republic of</option>
<option label="Kuwait" value="number:414">Kuwait</option>
<option label="Kyrgyzstan" value="number:417">Kyrgyzstan</option>
<option label="Lao People's Democratic Republic" value="number:418">Lao People's Democratic Republic</option>
<option label="Latvia" value="number:428">Latvia</option>
<option label="Lebanon" value="number:422">Lebanon</option>
<option label="Lesotho" value="number:426">Lesotho</option>
<option label="Liberia" value="number:430">Liberia</option>
<option label="Libya" value="number:434">Libya</option>
<option label="Liechtenstein" value="number:438">Liechtenstein</option>
<option label="Lithuania" value="number:440">Lithuania</option>
<option label="Luxembourg" value="number:442">Luxembourg</option>
<option label="Macao" value="number:446">Macao</option>
<option label="Macedonia, the former Yugoslav Republic of" value="number:807">Macedonia, the former Yugoslav Republic of</option>
<option label="Madagascar" value="number:450">Madagascar</option>
<option label="Malawi" value="number:454">Malawi</option>
<option label="Malaysia" value="number:458">Malaysia</option>
<option label="Maldives" value="number:462">Maldives</option>
<option label="Mali" value="number:466">Mali</option>
<option label="Malta" value="number:470">Malta</option>
<option label="Marshall Islands" value="number:584">Marshall Islands</option>
<option label="Martinique" value="number:474">Martinique</option>
<option label="Mauritania" value="number:478">Mauritania</option>
<option label="Mauritius" value="number:480">Mauritius</option>
<option label="Mayotte" value="number:175">Mayotte</option>
<option label="Mexico" value="number:484">Mexico</option>
<option label="Micronesia, Federated States of" value="number:583">Micronesia, Federated States of</option>
<option label="Moldova, Republic of" value="number:498">Moldova, Republic of</option>
<option label="Monaco" value="number:492">Monaco</option>
<option label="Mongolia" value="number:496">Mongolia</option>
<option label="Montenegro" value="number:499">Montenegro</option>
<option label="Montserrat" value="number:500">Montserrat</option>
<option label="Morocco" value="number:504">Morocco</option>
<option label="Mozambique" value="number:508">Mozambique</option>
<option label="Myanmar" value="number:104">Myanmar</option>
<option label="Namibia" value="number:516">Namibia</option>
<option label="Nauru" value="number:520">Nauru</option>
<option label="Nepal" value="number:524">Nepal</option>
<option label="Netherlands" value="number:528">Netherlands</option>
<option label="New Caledonia" value="number:540">New Caledonia</option>
<option label="New Zealand" value="number:554">New Zealand</option>
<option label="Nicaragua" value="number:558">Nicaragua</option>
<option label="Niger" value="number:562">Niger</option>
<option label="Nigeria" value="number:566">Nigeria</option>
<option label="Niue" value="number:570">Niue</option>
<option label="Norfolk Island" value="number:574">Norfolk Island</option>
<option label="Northern Mariana Islands" value="number:580">Northern Mariana Islands</option>
<option label="Norway" value="number:578">Norway</option>
<option label="Oman" value="number:512">Oman</option>
<option label="Pakistan" value="number:586">Pakistan</option>
<option label="Palau" value="number:585">Palau</option>
<option label="Palestinian Territory, Occupied" value="number:275">Palestinian Territory, Occupied</option>
<option label="Panama" value="number:591">Panama</option>
<option label="Papua New Guinea" value="number:598">Papua New Guinea</option>
<option label="Paraguay" value="number:600">Paraguay</option>
<option label="Peru" value="number:604">Peru</option>
<option label="Philippines" value="number:608">Philippines</option>
<option label="Pitcairn" value="number:612">Pitcairn</option>
<option label="Poland" value="number:616">Poland</option>
<option label="Portugal" value="number:620">Portugal</option>
<option label="Puerto Rico" value="number:630">Puerto Rico</option>
<option label="Qatar" value="number:634">Qatar</option>
<option label="Réunion" value="number:638">Réunion</option>
<option label="Romania" value="number:642">Romania</option>
<option label="Russian Federation" value="number:643">Russian Federation</option>
<option label="Rwanda" value="number:646">Rwanda</option>
<option label="Saint Barthélemy" value="number:652">Saint Barthélemy</option>
<option label="Saint Helena, Ascension and Tristan da Cunha" value="number:654">Saint Helena, Ascension and Tristan da Cunha</option>
<option label="Saint Kitts and Nevis" value="number:659">Saint Kitts and Nevis</option>
<option label="Saint Lucia" value="number:662">Saint Lucia</option>
<option label="Saint Martin (French part)" value="number:663">Saint Martin (French part)</option>
<option label="Saint Pierre and Miquelon" value="number:666">Saint Pierre and Miquelon</option>
<option label="Saint Vincent and the Grenadines" value="number:670">Saint Vincent and the Grenadines</option>
<option label="Samoa" value="number:882">Samoa</option>
<option label="San Marino" value="number:674">San Marino</option>
<option label="Sao Tome and Principe" value="number:678">Sao Tome and Principe</option>
<option label="Saudi Arabia" value="number:682">Saudi Arabia</option>
<option label="Senegal" value="number:686">Senegal</option>
<option label="Serbia" value="number:688">Serbia</option>
<option label="Seychelles" value="number:690">Seychelles</option>
<option label="Sierra Leone" value="number:694">Sierra Leone</option>
<option label="Singapore" value="number:702">Singapore</option>
<option label="Sint Maarten (Dutch part)" value="number:534">Sint Maarten (Dutch part)</option>
<option label="Slovakia" value="number:703">Slovakia</option>
<option label="Slovenia" value="number:705">Slovenia</option>
<option label="Solomon Islands" value="number:90">Solomon Islands</option>
<option label="Somalia" value="number:706">Somalia</option>
<option label="South Africa" value="number:710">South Africa</option>
<option label="South Georgia and the South Sandwich Islands" value="number:239">South Georgia and the South Sandwich Islands</option>
<option label="South Sudan" value="number:728">South Sudan</option>
<option label="Spain" value="number:724">Spain</option>
<option label="Sri Lanka" value="number:144">Sri Lanka</option>
<option label="Sudan" value="number:729">Sudan</option>
<option label="Suriname" value="number:740">Suriname</option>
<option label="Svalbard and Jan Mayen" value="number:744">Svalbard and Jan Mayen</option>
<option label="Swaziland" value="number:748">Swaziland</option>
<option label="Sweden" value="number:752">Sweden</option>
<option label="Switzerland" value="number:756">Switzerland</option>
<option label="Syrian Arab Republic" value="number:760">Syrian Arab Republic</option>
<option label="Taiwan, Province of China" value="number:158">Taiwan, Province of China</option>
<option label="Tajikistan" value="number:762">Tajikistan</option>
<option label="Tanzania, United Republic of" value="number:834">Tanzania, United Republic of</option>
<option label="Thailand" value="number:764">Thailand</option>
<option label="Timor-Leste" value="number:626">Timor-Leste</option>
<option label="Togo" value="number:768">Togo</option>
<option label="Tokelau" value="number:772">Tokelau</option>
<option label="Tonga" value="number:776">Tonga</option>
<option label="Trinidad and Tobago" value="number:780">Trinidad and Tobago</option>
<option label="Tunisia" value="number:788">Tunisia</option>
<option label="Turkey" value="number:792">Turkey</option>
<option label="Turkmenistan" value="number:795">Turkmenistan</option>
<option label="Turks and Caicos Islands" value="number:796">Turks and Caicos Islands</option>
<option label="Tuvalu" value="number:798">Tuvalu</option>
<option label="Uganda" value="number:800">Uganda</option>
<option label="Ukraine" value="number:804">Ukraine</option>
<option label="United Arab Emirates" value="number:784">United Arab Emirates</option>
<option label="United Kingdom" value="number:826">United Kingdom</option>
<option label="United States" value="number:840">United States</option>
<option label="United States Minor Outlying Islands" value="number:581">United States Minor Outlying Islands</option>
<option label="Uruguay" value="number:858">Uruguay</option>
<option label="Uzbekistan" value="number:860">Uzbekistan</option>
<option label="Vanuatu" value="number:548">Vanuatu</option>
<option label="Venezuela, Bolivarian Republic of" value="number:862">Venezuela, Bolivarian Republic of</option>
<option label="Viet Nam" value="number:704">Viet Nam</option>
<option label="Virgin Islands, British" value="number:92">Virgin Islands, British</option>
<option label="Virgin Islands, U.S." value="number:850">Virgin Islands, U.S.</option>
<option label="Wallis and Futuna" value="number:876">Wallis and Futuna</option>
<option label="Western Sahara" value="number:732">Western Sahara</option>
<option label="Yemen" value="number:887">Yemen</option>
<option label="Zambia" value="number:894">Zambia</option>
<option label="Zimbabwe" value="number:716">Zimbabwe</option>
</select>
<label for="billing_country" class="order-1">Country</label>
</div>
</div>
</div>
<div class="row mx-n8">
<div class="col-6 px-8 ng-hide" ng-show="isUnitedStates(order.billing_address.country)">
<div class="form-group d-flex flex-column">
<select class="form-control order-2 ng-pristine ng-untouched ng-valid ng-empty" id="billing_state" name="billing_state" ng-model="order.billing_address.region" ng-options="state.data as state.label for state in states" autofill=""
autofill-type-hint="">
<option value="" class="" selected="selected">Select State</option>
<option label="Alabama" value="string:AL">Alabama</option>
<option label="Alaska" value="string:AK">Alaska</option>
<option label="Arizona" value="string:AZ">Arizona</option>
<option label="Arkansas" value="string:AR">Arkansas</option>
<option label="Armed Forces America" value="string:AA">Armed Forces America</option>
<option label="Armed Forces Europe" value="string:AE">Armed Forces Europe</option>
<option label="Armed Forces Pacific" value="string:AP">Armed Forces Pacific</option>
<option label="California" value="string:CA">California</option>
<option label="Colorado" value="string:CO">Colorado</option>
<option label="Connecticut" value="string:CT">Connecticut</option>
<option label="Delaware" value="string:DE">Delaware</option>
<option label="District of Columbia" value="string:DC">District of Columbia</option>
<option label="Florida" value="string:FL">Florida</option>
<option label="Georgia" value="string:GA">Georgia</option>
<option label="Hawaii" value="string:HI">Hawaii</option>
<option label="Idaho" value="string:ID">Idaho</option>
<option label="Illinois" value="string:IL">Illinois</option>
<option label="Indiana" value="string:IN">Indiana</option>
<option label="Iowa" value="string:IA">Iowa</option>
<option label="Kansas" value="string:KS">Kansas</option>
<option label="Kentucky" value="string:KY">Kentucky</option>
<option label="Louisiana" value="string:LA">Louisiana</option>
<option label="Maine" value="string:ME">Maine</option>
<option label="Maryland" value="string:MD">Maryland</option>
<option label="Massachusetts" value="string:MA">Massachusetts</option>
<option label="Michigan" value="string:MI">Michigan</option>
<option label="Minnesota" value="string:MN">Minnesota</option>
<option label="Mississippi" value="string:MS">Mississippi</option>
<option label="Missouri" value="string:MO">Missouri</option>
<option label="Montana" value="string:MT">Montana</option>
<option label="Nebraska" value="string:NE">Nebraska</option>
<option label="Nevada" value="string:NV">Nevada</option>
<option label="New Hampshire" value="string:NH">New Hampshire</option>
<option label="New Jersey" value="string:NJ">New Jersey</option>
<option label="New Mexico" value="string:NM">New Mexico</option>
<option label="New York" value="string:NY">New York</option>
<option label="North Carolina" value="string:NC">North Carolina</option>
<option label="North Dakota" value="string:ND">North Dakota</option>
<option label="Ohio" value="string:OH">Ohio</option>
<option label="Oklahoma" value="string:OK">Oklahoma</option>
<option label="Oregon" value="string:OR">Oregon</option>
<option label="Pennsylvania" value="string:PA">Pennsylvania</option>
<option label="Rhode Island" value="string:RI">Rhode Island</option>
<option label="South Carolina" value="string:SC">South Carolina</option>
<option label="South Dakota" value="string:SD">South Dakota</option>
<option label="Tennessee" value="string:TN">Tennessee</option>
<option label="Texas" value="string:TX">Texas</option>
<option label="Utah" value="string:UT">Utah</option>
<option label="Vermont" value="string:VT">Vermont</option>
<option label="Virginia" value="string:VA">Virginia</option>
<option label="Washington" value="string:WA">Washington</option>
<option label="West Virginia" value="string:WV">West Virginia</option>
<option label="Wisconsin" value="string:WI">Wisconsin</option>
<option label="Wyoming" value="string:WY">Wyoming</option>
</select>
<label for="billing_state" class="order-1">State</label>
</div>
</div>
<div class="col-6 px-8 ng-hide" ng-show="isCanada(order.billing_address.country)">
<div class="form-group d-flex flex-column">
<select class="form-control order-2 ng-pristine ng-untouched ng-valid ng-empty" id="billing_region" name="billing_region" ng-model="order.billing_address.region" ng-options="province.data as province.label for province in canadianProvinces"
autofill="" autofill-type-hint="">
<option value="" class="" selected="selected">Select Province</option>
<option label="Alberta" value="string:AB">Alberta</option>
<option label="British Columbia" value="string:BC">British Columbia</option>
<option label="Manitoba" value="string:MB">Manitoba</option>
<option label="New Brunswick" value="string:NB">New Brunswick</option>
<option label="Newfoundland and Labrador" value="string:NL">Newfoundland and Labrador</option>
<option label="Northwest Territories" value="string:NT">Northwest Territories</option>
<option label="Nova Scotia" value="string:NS">Nova Scotia</option>
<option label="Nunavut" value="string:NU">Nunavut</option>
<option label="Ontario" value="string:ON">Ontario</option>
<option label="Prince Edward Island" value="string:PE">Prince Edward Island</option>
<option label="Quebec" value="string:QC">Quebec</option>
<option label="Saskatchewan" value="string:SK">Saskatchewan</option>
<option label="Yukon" value="string:YT">Yukon</option>
</select>
<label for="billing_state" class="order-1">Province</label>
</div>
</div>
<div class="col-6 px-8" ng-show="!isUnitedStates(order.billing_address.country) && !isCanada(order.billing_address.country)">
<div class="form-group d-flex flex-column">
<input class="form-control order-2 ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" id="billing_region" name="billing_region" type="text" spellcheck="false" ng-model="order.billing_address.region" value="" autofill=""
required="">
<label for="billing_region" class="order-1">Region</label>
</div>
</div>
<div class="col-6 px-8 ng-hide" ng-show="isUnitedStates(order.billing_address.country)">
<div class="form-group d-flex flex-column">
<input type="text" class="form-control order-2 ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-valid-maxlength" id="billing_zip" name="billing_zip" maxlength="5" spellcheck="false" ng-model="order.billing_address.postal"
value="" autofill="" required="">
<label for="billing_zip" class="order-1">ZIP Code</label>
</div>
</div>
<div class="col-6 px-8" ng-show="!isUnitedStates(order.billing_address.country)">
<div class="form-group d-flex flex-column">
<input type="text" class="form-control order-2 ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" id="billing_postal_code" name="billing_postal_code" spellcheck="false" ng-model="order.billing_address.postal" value=""
autofill="" required="">
<label for="billing_postal_code" class="order-1">Postal Code</label>
</div>
</div>
</div>
</div>
<div class="border-bottom mb-16">
</div>
<div class="mb-16">
<h3 class="my-32 pb-24 border-bottom text-uppercase">Payment Options</h3>
<div class="border-bottom mb-16">
<div class="custom-control custom-radio">
<input type="radio" class="custom-control-input selected" name="radio_option" id="product-option-827597" ng-click="setProductOption('product_option',827597 )" ng-checked="checkoutContext.cart.settings.selected_payment_option === 827597"
checked="checked">
<label class="custom-control-label d-block" for="product-option-827597">
<div class="row no-gutters align-items-center">
<div class="col-auto">
<span></span>
</div>
<div class="col">
<p>Everyday Disciple MAKERS</p>
</div>
<div class="col-auto text-right">
<p>$300.00</p>
<small class="text-muted">Then $300.00 monthly</small>
</div>
</div>
</label>
</div>
</div>
<div class="border-bottom mb-16">
<div class="custom-control custom-radio">
<input type="radio" class="custom-control-input" name="radio_option" id="product-option-737068" ng-click="setProductOption('product_option',737068 )" ng-checked="checkoutContext.cart.settings.selected_payment_option === 737068">
<label class="custom-control-label d-block" for="product-option-737068">
<div class="row no-gutters align-items-center">
<div class="col-auto">
<span></span>
</div>
<div class="col">
<p>Everyday Disciple MAKERS-Annual Pay</p>
</div>
<div class="col-auto text-right">
<p>$3300.00</p>
<small class="text-muted"></small>
</div>
</div>
</label>
</div>
</div>
</div>
<h3 class="mt-32 text-uppercase">Payment Methods</h3>
<div id="payments" class="tpl-t1__payment mt-16 mb-24">
<div class="row">
<div class="col-12 mt-16 order-3 ml-20 pr-0">
<div class="custom-control custom-radio m-0">
<input type="radio" id="creditCardRadio" name="paymentMethods" data-toggle="collapse" data-target="#cards:not(.show)" class="custom-control-input" ng-click="setPaymentType('cc_processor')" aria-expanded="true" checked="">
<label class="custom-control-label d-flex align-items-center" for="creditCardRadio">
<div class="payment-method-label"><img class="sampay-icon" src="https://d2n844f18s487r.cloudfront.net/modules/frontend/img/payment/sampay-wallet.svg" alt="SamPay Wallet"><span>Card & More</span></div>
</label>
</div>
</div>
<div id="cards" class="col-12 collapse order-3 show " data-parent="#payments">
<div class="payment-element-container">
<div class="payment-form cc-processor-form sampay-processor-form" ng-show="processor_selection == 'cc_processor'">
<!-- ngIf: renderingPaymentElement -->
<!-- ngIf: !renderingPaymentElement -->
<div ng-if="!renderingPaymentElement" class="ng-scope">
<stripe-element id="payment-element" instance="paymentElement" class="stripe-payment-element ng-isolate-scope">
<div stripe-element-decorator="" class="StripeElement">
<div class="__PrivateStripeElement"
style="margin: -4px 0px !important; padding: 0px !important; border: none !important; display: block !important; background: transparent !important; position: relative !important; opacity: 1 !important; clear: both !important; transition: height 0.35s ease 0s !important;">
<iframe name="__privateStripeFrame0068" frameborder="0" allowtransparency="true" scrolling="no" role="presentation" allow="payment *; publickey-credentials-get *"
src="https://js.stripe.com/v3/elements-inner-payment-906df3890a41d773a20effca4879d7f9.html#wait=true&rtl=false&publicOptions[paymentMethodOrder][0]=card&publicOptions[paymentMethodOrder][1]=affirm&publicOptions[paymentMethodOrder][2]=afterpay_clearpay&publicOptions[paymentMethodOrder][3]=klarna&publicOptions[terms][applePay]=never&publicOptions[terms][auBecsDebit]=never&publicOptions[terms][bancontact]=never&publicOptions[terms][card]=never&publicOptions[terms][cashapp]=never&publicOptions[terms][googlePay]=never&publicOptions[terms][ideal]=never&publicOptions[terms][paypal]=never&publicOptions[terms][sepaDebit]=never&publicOptions[terms][sofort]=never&publicOptions[terms][usBankAccount]=never&publicOptions[wallets][applePay]=never&publicOptions[wallets][googlePay]=never&publicOptions[layout][type]=accordion&publicOptions[layout][defaultCollapsed]=false&publicOptions[layout][radios]=false&publicOptions[layout][spacedAccordionItems]=true&stripeAccount=acct_16dOOOJdiXHXAkhh&componentName=payment&keyMode=live&apiKey=pk_live_NNX27kZQDAPiNsF78lllGNd0&referrer=https%3A%2F%2Fenroll.everydaydisciplemakers.com%2F&controllerId=__privateStripeController0061"
title="Secure payment input frame"
style="border: 0px !important; margin: -4px; padding: 0px !important; width: calc(100% + 8px); min-width: 100% !important; overflow: hidden !important; display: block !important; user-select: none !important; transform: translate(0px) !important; color-scheme: light only !important; height: 438.5px; opacity: 1; transition: height 0.35s ease 0s, opacity 0.4s ease 0.1s;"></iframe>
</div>
</div>
</stripe-element>
</div><!-- end ngIf: !renderingPaymentElement -->
</div>
</div>
</div>
<div class="col-12 mt-16 order-1 ml-20 pr-0">
<div class="custom-control custom-radio m-0">
<input type="radio" id="payPalRadio" name="paymentMethods" data-toggle="collapse" data-target="#paypal:not(.show)" class="custom-control-input" ng-click="setPaymentType('paypal')" aria-expanded="false">
<label class="custom-control-label d-flex align-items-center" for="payPalRadio">
<div class="payment-method-label"><img class="paypal-icon-v2" src="https://d2n844f18s487r.cloudfront.net/modules/frontend/img/payment/paypal-v2.svg" alt="PayPal"><span>PayPal</span></div>
</label>
</div>
</div>
<div id="paypal" class="col-12 collapse order-1" data-parent="#payments">
<div class="alternate-payments">
<img class="payment-logo" src="https://d2n844f18s487r.cloudfront.net/modules/frontend/img/payment/paypal-redirect.svg" alt="PayPal logo">
<p>PayPal selected.</p>
<div>
<img class="external-link" src="https://d2n844f18s487r.cloudfront.net/modules/frontend/img/payment/external-link.svg">
<p class="payment-subtext">After submitting, you will be redirected to the PayPal website to fill out your payment information. You will be redirected back to our site once the payment is completed.</p>
</div>
</div>
</div>
</div>
</div>
<div id="order-summary-widget" box-loading="contextRefresh">
<div id="product-list" class="box">
<!-- ngRepeat: invoiceItem in checkoutContext.order.invoice.items -->
<div class="product-item ng-scope" ng-repeat="invoiceItem in checkoutContext.order.invoice.items">
<div class="product-label-col">
<span class="product-item-name ng-binding">Everyday Disciple MAKERS</span>
<!-- ngIf: subscriptionsByProductId[invoiceItem.product_id] -->
<div ng-if="subscriptionsByProductId[invoiceItem.product_id]" class="ng-scope">
<span class="price-item-detail">
<span class="ng-binding">Then $300.00 monthly</span>
</span>
</div><!-- end ngIf: subscriptionsByProductId[invoiceItem.product_id] -->
<!-- ngIf: invoiceItem.type === 'bump' -->
</div>
<div class="product-price-col float-right text-right">
<!-- ngIf: invoiceItem.quantity > 1 --><span class="unit-amount ng-binding">$300.00</span>
</div>
</div><!-- end ngRepeat: invoiceItem in checkoutContext.order.invoice.items -->
</div>
<div id="summary-totals" class="box">
<div class="invoice-item subtotal-row ng-hide" ng-show="checkoutContext.order.invoice.subtotal !== checkoutContext.order.invoice.total">
<div class="invoice-label-col">
<span class="invoice-item-label">Subtotal:</span>
</div>
<div class="invoice-amount-col float-right text-right">
<span class="invoice-item-amount ng-binding">$300.00</span>
</div>
</div>
<div class="invoice-item tax-row ng-hide" ng-show="checkoutContext.order.invoice.tax !== 0">
<div class="invoice-label-col">
<span class="invoice-item-label">Tax:</span>
</div>
<div class="invoice-amount-col float-right text-right">
<span class="invoice-item-amount ng-binding">$0.00</span>
</div>
</div>
<div class="invoice-item shipping-row ng-hide" ng-show="checkoutContext.order.invoice.shipping !== 0">
<div class="invoice-label-col">
<span class="invoice-item-label">Shipping:</span>
</div>
<div class="invoice-amount-col float-right text-right">
<span class="invoice-item-amount ng-binding">$0.00</span>
</div>
</div>
<div class="invoice-item discount-row ng-hide" ng-show="checkoutContext.order.invoice.discount !== 0">
<div class="invoice-label-col">
<span class="invoice-item-label">Discounts:</span>
</div>
<div class="invoice-amount-col float-right text-right">
<span class="invoice-item-amount ng-binding">-$0.00</span>
</div>
</div>
<div class="invoice-item total-row">
<div class="invoice-label-col">
<span class="invoice-item-label">Total:</span>
</div>
<div class="invoice-amount-col float-right text-right">
<span class="invoice-item-amount ng-binding" id="total">$300.00 (USD)</span>
</div>
</div>
</div>
</div>
<!-- ngIf: processor_selection !== 'digital_wallet' --><button type="submit" class="btn btn-danger w-100 mb-16 main-cta ng-scope" id="placeOrder" name="placeOrder" ng-click="placeOrder('Wm9MCg70R7EzYNKXcZAQYD2j')"
ng-disabled="shippingCountryIsRestricted || isProcessingOrder" ng-if="processor_selection !== 'digital_wallet'"> ENROLL NOW </button><!-- end ngIf: processor_selection !== 'digital_wallet' -->
<div id="payment-request-button" class="mb-16 ng-hide" ng-show="processor_selection === 'digital_wallet'"></div>
<div class="g-recaptcha-container">
<script type="text/javascript">
var recaptchaChallengeSeen = false;
var recaptchaCallback = function(response) {
window.recaptchaResponse = response;
};
var onloadCallback = function() {
window.recaptchaWidgetId = grecaptcha.render('submit', {
'sitekey': '6LfyULUmAAAAAJld89qgZEGDDIGnjfWqZGBkXh3t',
'callback': recaptchaCallback,
'size': 'invisible'
});
};
const domObserver = new MutationObserver(() => {
const iframe = document.querySelector("iframe[src^=\"https://www.google.com/recaptcha\"][src*=\"bframe\"]");
if (!iframe) {
return;
}
domObserver.disconnect();
const recaptchaContainerObserver = new MutationObserver(() => {
if (iframe.parentNode.parentNode.style.visibility !== "visible") {
return;
}
recaptchaContainerObserver.disconnect();
recaptchaChallengeSeen = true;
});
recaptchaContainerObserver.observe(iframe.parentNode.parentNode, {
attributes: true
});
});
domObserver.observe(document.documentElement || document.body, {
childList: true,
subtree: true
});
window.resetRecaptcha = function() {
window.recaptchaResponse = undefined;
grecaptcha.reset(window.recaptchaWidgetId);
recaptchaChallengeSeen = false;
domObserver.observe(document.documentElement || document.body, {
childList: true,
subtree: true
});
}
</script>
<input id="submit" type="hidden" value="Submit" style="">
<script src="https://www.google.com/recaptcha/api.js?onload=onloadCallback&render=explicit" async="" defer=""></script>
<script>
const sleepUntil = async (f, timeoutMs) => {
return new Promise((resolve, reject) => {
const timeWas = new Date();
const wait = setInterval(function() {
if (f()) {
clearInterval(wait);
resolve();
} else if (new Date() - timeWas > timeoutMs) { // Timeout
clearInterval(wait);
reject();
}
}, 20);
});
}
function fetchToken() {
window.resetRecaptcha();
return new Promise(async function(resolve, reject) {
grecaptcha.reset();
grecaptcha.execute(window.recaptchaWidgetId);
var responseReceived = false;
try {
await sleepUntil(() => window.recaptchaResponse, 60000);
responseReceived = true;
resolve('');
} catch {
reject('reCAPTCHA timeout exceeded!');
}
snowplow('trackSelfDescribingEvent', {
event: {
schema: 'iglu:com.samcart/recaptcha_challenge_shown_event/jsonschema/1-0-0',
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}
});
snowplow('trackSelfDescribingEvent', {
event: {
schema: 'iglu:com.samcart/recaptcha_challenge_response_received_event/jsonschema/1-0-0',
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});
});
}
</script>
</div>
</form>Text Content
Contact us at: support@everydaydisciple.com or Call: 253-222-8493 What Our Members Say... “We needed to shift from a traditional Sunday-only understanding of church to a living missional family that is confident in its identity and living out a life of faith. This framework has really helped to catalyze growth in depth of our church family’s discipleship.” Pastor Paul A. “We’d known the concepts of discipleship from previous books and trainings, but still needed specific steps to take to get where we wanted to be… which is life as a disciple fully integrated into everyday life. We now have clarity on purpose, mindset, posture, and a process of discipleship.” Pastor Aaron & Rachel K. CONTACT INFORMATION First Name Last Name Email Address BILLING INFORMATION Address City CountryUnited StatesAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia, Plurinational State ofBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, the Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, the former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuela, Bolivarian Republic ofViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Select StateAlabamaAlaskaArizonaArkansasArmed Forces AmericaArmed Forces EuropeArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State Select ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Region ZIP Code Postal Code PAYMENT OPTIONS Everyday Disciple MAKERS $300.00 Then $300.00 monthly Everyday Disciple MAKERS-Annual Pay $3300.00 PAYMENT METHODS Card & More PayPal PayPal selected. After submitting, you will be redirected to the PayPal website to fill out your payment information. You will be redirected back to our site once the payment is completed. Everyday Disciple MAKERS Then $300.00 monthly $300.00 Subtotal: $300.00 Tax: $0.00 Shipping: $0.00 Discounts: -$0.00 Total: $300.00 (USD) ENROLL NOW © 2024 everydaydisciple.com. All Rights Reserved. PROCESSING