donate.greenpeace.in
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Submitted URL: http://donate.greenpeace.in/
Effective URL: https://donate.greenpeace.in/
Submission: On February 06 via api from NL — Scanned from NL
Effective URL: https://donate.greenpeace.in/
Submission: On February 06 via api from NL — Scanned from NL
Form analysis
1 forms found in the DOMPOST https://donate.greenpeace.in/payumoney/requstHandler.php
<form action="https://donate.greenpeace.in/payumoney/requstHandler.php" id="supporter_form" method="post" novalidate="novalidate">
<h3>Join us and protect the planet! </h3>
<hr>
<div class="row">
<div class="col-sm-12">
<label><input id="isIndian" type="checkbox" checked=""> I declare that I'm an Indian national</label>
</div>
<script>
$(document).ready(function() {
$("#isIndian").click(function() {
if ($(this).is(':checked')) {
$('#notIndian').show();
$('#Indian').hide();
} else {
$('#Indian').show();
$('#notIndian').hide();
}
});
});
</script>
</div>
<div id="notIndian">
<hr>
<fieldset class="control-group">
<label class="control-label required h4" for="supporter_aradio">Select the Amount</label>
<div class="controls">
<div class="row" id="amount" style="display: ">
<div class="col-sm-2 col-md-2 col-xs-6"><input id="amount-5000" class="aradio" name="supporter[aradio]" type="radio" value="5000" checked=""><label for="amount-5000"> ₹ 5000 </label></div>
<div class="col-sm-2 col-md-2 col-xs-6"><input id="amount-7500" class="aradio" name="supporter[aradio]" type="radio" value="7500"><label for="amount-7500"> ₹ 7500 </label></div>
<div class="col-sm-2 col-md-2 col-xs-6"><input id="amount-10000" class="aradio" name="supporter[aradio]" type="radio" value="10000"><label for="amount-10000"> ₹ 10000 </label></div>
<div class="col-sm-2 col-md-2 col-xs-6">
<input id="amount-other" class="aradio" name="supporter[aradio]" type="radio" value="other"><label for="amount-other"> Other </label>
</div>
<div class="col-sm-4 col-md-4 col-xs-6">
<input class="input-xlarge input-with-feedback" id="supporter_amount" name="supporter[amount]" style="display:none;" type="text" value="5000">
</div>
</div>
</div>
</fieldset>
<hr>
<div class="row">
<div class="col-md-12">
<h4>Your Personal Information</h4>
</div>
</div>
<div class="row">
<div class="col-sm-6 col-md-6">
<fieldset class="control-group">
<label class="control-label required" for="supporter_fname">First name</label>
<div class="controls">
<input class="input-xlarge input-with-feedback" id="supporter_fname" name="supporter[fname]" type="text">
</div>
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<div class="col-sm-6 col-md-6">
<fieldset class="control-group">
<label class="control-label required" for="supporter_lname">Last name</label>
<div class="controls">
<input class="input-xlarge input-with-feedback" id="supporter_lname" name="supporter[lname]" type="text">
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</fieldset>
</div>
</div>
<hr>
<div class="row">
<div class="col-md-12">
<h4>Your Contact Information</h4>
</div>
</div>
<div class="row">
<div class="col-sm-6 col-md-6">
<fieldset class="control-group">
<label class="control-label required" for="supporter_phone_mobile">Cellular phone</label>
<div class="controls">
<input class="input-xlarge input-with-feedback phonemask" id="supporter_phone_mobile" name="supporter[phone_mobile]" type="tel" placeholder="___ ___ ____">
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<div class="col-sm-6 col-md-6">
<fieldset class="control-group">
<label class="control-label required" for="supporter_email">E-mail address</label>
<div class="controls">
<input class="input-xlarge input-with-feedback" id="supporter_email" name="supporter[email]" type="email">
</div>
</fieldset>
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</div>
<div class="row">
<div class="col-sm-6 col-md-6">
<fieldset class="control-group">
<label class="control-label required" for="supporter_address">Address</label>
<div class="controls">
<textarea class="input-xlarge input-with-feedback" id="supporter_address" name="supporter[address]" rows="6" style="max-width:100%;" type="text"></textarea>
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</fieldset>
</div>
<div class="col-sm-6 col-md-6">
<fieldset class="control-group">
<label class="control-label required" for="supporter_region">Town / City</label>
<div class="controls">
<input class="input-xlarge input-with-feedback" id="supporter_region" name="supporter[region_string]" type="text">
<!--<input class='input-xlarge input-with-feedback' id='region' name='supporter[region]' type='hidden'>-->
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<label class="control-label required" for="supporter_state">State</label>
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<select id="supporter_state" name="supporter[state]" class="input-xlarge input-with-feedback" style="width: 100%; padding: 4px; margin: 0; font-size: 16px;">
<option value="">Select a State</option>
<option value="an">Andaman and Nicobar Islands</option>
<option value="ap">Andhra Pradesh</option>
<option value="ar">Arunachal Pradesh</option>
<option value="as">Assam</option>
<option value="br">Bihar</option>
<option value="ch">Chandigarh</option>
<option value="ct">Chhattisgarh</option>
<option value="dn">Dadra and Nagar Haveli</option>
<option value="dd">Daman and Diu</option>
<option value="dl">Delhi</option>
<option value="ga">Goa</option>
<option value="gj">Gujarat</option>
<option value="hr">Haryana</option>
<option value="hp">Himachal Pradesh</option>
<option value="jk">Jammu and Kashmir</option>
<option value="jh">Jharkhand</option>
<option value="ka">Karnataka</option>
<option value="kl">Kerala</option>
<option value="ld">Lakshadweep</option>
<option value="mp">Madhya Pradesh</option>
<option value="mh">Maharashtra</option>
<option value="mn">Manipur</option>
<option value="ml">Meghalaya</option>
<option value="mz">Mizoram</option>
<option value="nl">Nagaland</option>
<option value="or">Orissa</option>
<option value="py">Puducherry</option>
<option value="pb">Punjab</option>
<option value="rj">Rajasthan</option>
<option value="sk">Sikkim</option>
<option value="tg">Telangana</option>
<option value="tn">Tamil Nadu</option>
<option value="tr">Tripura</option>
<option value="up">Uttar Pradesh</option>
<option value="ut">Uttarakhand</option>
<option value="wb">West Bengal</option>
</select>
</div>
</fieldset>
</div>
</div>
<div class="row">
<div class="col-sm-6 col-md-6">
<fieldset class="control-group">
<label class="control-label required" for="supporter_pincode">Pincode</label>
<div class="controls">
<input class="input-xlarge input-with-feedback" id="supporter_pincode" name="supporter[pincode]" type="text">
</div>
</fieldset>
</div>
<div class="col-sm-6 col-md-6">
<fieldset class="control-group">
<label class="control-label required" for="supporter_country">Country</label>
<div class="controls">
<input class="input-xlarge input-with-feedback readonly" id="supporter_country" name="supporter[country]" type="text" value="India" readonly="true">
</div>
</fieldset>
</div>
</div>
<div class="row">
<div class="col-sm-6 col-md-6"> </div>
<div class="col-sm-6 col-md-6">
<br>
<div class="form-actions">
<input name="utm_campaign" type="hidden" value="">
<input name="utm_source" type="hidden" value="">
<input name="utm_medium" type="hidden" value="">
<input name="utm_term" type="hidden" value="">
<input name="utm_content" type="hidden" value="">
<input class="input-xlarge btn btn-success" id="submit" style="padding:18px 0;" type="submit" value="Donate">
</div>
</div>
</div>
</div>
<div id="Indian" style="display: none;">
<br>
<h3>Your contribution is important to us.</h3>
<p>As a foreign national, you can donate off-line by sending a cheque in favour of ‘<strong>Greenpeace India Society</strong>’.</p>
<p>Please mail your cheque, including your residential address and Passport number to the following address: </p> Greenpeace India <br> No.338, 8th Cross<br> BTS Main Rd, Vinayaka Nagar<br> NGO Colony, Wilson Garden<br> Bangalore - 560 027<br>
Karnataka, India<br><br> For any assistance please call 1800-425-0374 (10:00am - 6:00pm) or Email <a href="mailto:supporter.services.in@greenpeace.org">supporter.services.in@greenpeace.org</a>
<p></p>
</div>
<hr>
</form>
Text Content
GREENPEACE INDIA Greenpeace India JOIN US AND PROTECT THE PLANET! -------------------------------------------------------------------------------- I declare that I'm an Indian national -------------------------------------------------------------------------------- Select the Amount ₹ 5000 ₹ 7500 ₹ 10000 Other -------------------------------------------------------------------------------- YOUR PERSONAL INFORMATION First name Last name -------------------------------------------------------------------------------- YOUR CONTACT INFORMATION Cellular phone E-mail address Address Town / City State Select a State Andaman and Nicobar Islands Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh Dadra and Nagar Haveli Daman and Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Puducherry Punjab Rajasthan Sikkim Telangana Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal Pincode Country YOUR CONTRIBUTION IS IMPORTANT TO US. As a foreign national, you can donate off-line by sending a cheque in favour of ‘Greenpeace India Society’. Please mail your cheque, including your residential address and Passport number to the following address: Greenpeace India No.338, 8th Cross BTS Main Rd, Vinayaka Nagar NGO Colony, Wilson Garden Bangalore - 560 027 Karnataka, India For any assistance please call 1800-425-0374 (10:00am - 6:00pm) or Email supporter.services.in@greenpeace.org -------------------------------------------------------------------------------- Greenpeace is the only global environmental charity that accepts no corporate, government or political donations to remain independent. This means we rely totally on individual supporters like you to fund our work. By becoming a member you'll join Greenpeace in protecting our planet and finding solutions to our most important environmental issues. You'll enable us to investigate, campaign, and lobby for sustainable development for everyone. With your help, we'll expose environmental abuses and raise awareness to protect our oceans, forests, and our climate – the very life support systems of our planet. Greenpeace India has been working on various issues related to the environment, peace and disarmament since 2001. We have also built tools like Greenpeace Extra where people can easily start, run, and WIN their own local campaigns! The tool has tasted great success in different places in the country. Your donation is critical in running campaigns and enabling victories! We can't do it without your help. Thank you for your support. DONATE THROUGH PHONE Call : 1800 425 0374 (Toll Free)(Within India) / 080 22131899 ©2014 * Privacy policy * Copyright *