donate.bpr.org Open in urlscan Pro
151.101.193.91  Public Scan

Form analysis
1 forms found in the DOM

POST /node/9337

<form class="webform-client-form form-layouts one-column fundraiser-donation-form donation-messages-processed jquery-once-6-processed" enctype="multipart/form-data" action="/node/9337" method="post" id="webform-client-form-9337"
  accept-charset="UTF-8" novalidate="novalidate"><input type="hidden" name="g-recaptcha-response"
    value="03AFcWeA5N8R18clgXq0ELIX-50cjSM9yi1ONF97xAqSOW4qM7kpeqcszdT2-eMNjtIjFCkbKWWi3OY8sq7SnPRkfChRVdUgTKKNSn0ovoLDCrAPoi7Xx4nZeTs7YjQGKdcyvtPyy2NR1uQDGSWr0OkcmBXouOU9JuqC-_vhr_tr5qA-ufkfFZtbSB4cCJLIXzKR77ve4qU1LaBY7lvoXza-6NoY0ajG7HRiVzn2s785IGqvrp4hZ7QkCpm5Y4liUXVq4B1Eo9JhXeBPcAhO5xCReHB3irsIKQJU_K9rKrUhSAY7OuJGZ3aMEMssbaLIoWZ4NBuHxg_0xYlNABhKzGj0Rflv-7GxrCugNBNTFUd0CBUWOVldFQ70ngWghPAILsfi3CN6b0rXKZhoCiPLcYV5EzvEMH2_epNBYRZAXRl_Dq5riB5tOXp2VHVZirtvdWC78wePuJL0f-Y4cE5aY74Dm5z4WoNFMO82Gql3EGQCUSzHTNIn7Le2jNmdY1JirUtrQVmb89nGUiMpe66tb68Q55PSKOqH83qloxsc-3khPVI1Rhg7-o7y3ygHpbKgB_djYoDBVRrtvMYFHCMy0VP6hrs_i1WxYrYQOhO59EtgZoSgPxHPYAg1dTY95uujJvJGNJmosPscYamSfqER94CybYfAK3nBd3y9wDGSfvKlkrunb6vpXUpTw6tjjTzJk2RDS0reCLJQTuHmY1h-eKPVeMFGfaHo51Hm3B3l6UtkBUjOi7Isktg02MTIqUCjzs__VL2lZfJNqUEL2JGBkrqtZEheOSpXtUTztYcz3rN2V-6WXRHHRe9O5SoYcRqhDWy_Sfspwy4Mp6xu0nhbFaMLppsL2ZsjzSwYOGDkP7B2m_ZFiShicAsZRkH4-KH3YhZG_p7yA3oU8lz9C4-9rltDAzJLNKt6qx6_N8qWrzrTA7t6KmSwUqqm4UTnP1b74B-mit8w8tWYtFa5jKqHy-DXELTl3KqQsDWFWOireYA5yEzay6i7pLDcs_jxghEYIs-hFKlag77C0j9f3x-PFcR3K1Bc1TRK7jDZWFbI0NdtDIHdN5RVVWUSEacEpXEVrrkX2yY4Uo6ljJHew-SndnNhor77__K0S2NOqBE0c9vAW7VYEkURPNpyFmhgjmEJbipEWdWNSVsW36WSS-hUpDOZ4dppyiJ7R0oOl0KiUJeuMV3RvJyVWm2Dj_xwP3MOy8FguJ-2zoA23pZMx-FtRHAZxmv5leF_vq2RKAhUsSiyggl3DDn92O-2mUmpSyjrN_zqfpc_w0ujC_nHO0CJt8cv395rn1qXORWN1FJipYvBGP1g8N3NNN2fmT8VKI-s-xbyDEBtL2eODAYayKTgii6vJQGMGGJhVgR-XkqA4kQvxFA4swJQzf-Z4CFaL8YKpEKAyrp5iHECAA8H1DLh24gcbGJ28f9guEJmsoakr0RgS2XxbEW6kQVsDWKmLZ-TJ6hdNa9g-eYhsrfvgsPhkXkUJHAZpfdkvJtyKAAWP-N7Mk4UvCb5MDa7MVp6WcYMUSbqPf0tK2fxGxQtL2FWSp5nJA217I49tIyTiVjOMfQ-wMwg55KYri1FEcY0EeGkvijwaBJ-YN3u08NRSAd0ASzLpkO8MXKClv3GL-oPhty8Cr6E09v7vnAfZuZeEzhq7m3L1dwFIb-0x4">
  <fieldset class="webform-component-fieldset form-wrapper" id="webform-component-donation">
    <div class="fieldset-wrapper">
      <div class="form-item webform-component webform-component-radios control-group" id="webform-component-donation--recurs-monthly">
        <div id="edit-submitted-donation-recurs-monthly">
          <div class="form-item form-type-radio form-item-submitted-donation-recurs-monthly control-group">
            <input type="radio" id="edit-submitted-donation-recurs-monthly-1" name="submitted[donation][recurs_monthly]" value="recurs" checked="checked"> <label class="option" for="edit-submitted-donation-recurs-monthly-1">Monthly </label>
          </div>
          <div class="form-item form-type-radio form-item-submitted-donation-recurs-monthly control-group">
            <input type="radio" id="edit-submitted-donation-recurs-monthly-2" name="submitted[donation][recurs_monthly]" value="NO_RECURR"> <label class="option" for="edit-submitted-donation-recurs-monthly-2">One-time </label>
          </div>
        </div>
      </div>
      <div class="form-item webform-component webform-component-radios control-group" id="webform-component-donation--recurring-amount">
        <label for="edit-submitted-donation-recurring-amount">Please select your monthly gift: <span class="form-required">*</span></label>
        <div id="edit-submitted-donation-recurring-amount">
          <div class="form-item form-type-radio form-item-submitted-donation-recurring-amount control-group">
            <input type="radio" id="edit-submitted-donation-recurring-amount-1" name="submitted[donation][recurring_amount]" value="10"> <label class="option" for="edit-submitted-donation-recurring-amount-1">$10.00 monthly <span
                class="form-required">*</span></label>
          </div>
          <div class="form-item form-type-radio form-item-submitted-donation-recurring-amount control-group">
            <input type="radio" id="edit-submitted-donation-recurring-amount-2" name="submitted[donation][recurring_amount]" value="25"> <label class="option" for="edit-submitted-donation-recurring-amount-2">$25.00 monthly <span
                class="form-required">*</span></label>
          </div>
          <div class="form-item form-type-radio form-item-submitted-donation-recurring-amount control-group">
            <input type="radio" id="edit-submitted-donation-recurring-amount-3" name="submitted[donation][recurring_amount]" value="50"> <label class="option" for="edit-submitted-donation-recurring-amount-3">$50.00 monthly <span
                class="form-required">*</span></label>
          </div>
          <div class="form-item form-type-radio form-item-submitted-donation-recurring-amount control-group">
            <input type="radio" id="edit-submitted-donation-recurring-amount-4" name="submitted[donation][recurring_amount]" value="100"> <label class="option" for="edit-submitted-donation-recurring-amount-4">$100.00 monthly <span
                class="form-required">*</span></label>
          </div>
          <div class="form-item form-type-radio form-item-submitted-donation-recurring-amount control-group other">
            <input type="radio" id="edit-submitted-donation-recurring-amount-5" name="submitted[donation][recurring_amount]" value="other"> <label class="option" for="edit-submitted-donation-recurring-amount-5">Other <span
                class="form-required">*</span></label>
          </div>
        </div>
      </div>
      <div class="form-item webform-component webform-component-radios control-group" id="webform-component-donation--amount" style="display: none;">
        <label for="edit-submitted-donation-amount">Please select your one-time gift: </label>
        <div id="edit-submitted-donation-amount">
          <div class="form-item form-type-radio form-item-submitted-donation-amount control-group">
            <input type="radio" id="edit-submitted-donation-amount-1" name="submitted[donation][amount]" value="75"> <label class="option" for="edit-submitted-donation-amount-1">$75.00 </label>
          </div>
          <div class="form-item form-type-radio form-item-submitted-donation-amount control-group">
            <input type="radio" id="edit-submitted-donation-amount-2" name="submitted[donation][amount]" value="120"> <label class="option" for="edit-submitted-donation-amount-2">$120.00 </label>
          </div>
          <div class="form-item form-type-radio form-item-submitted-donation-amount control-group">
            <input type="radio" id="edit-submitted-donation-amount-3" name="submitted[donation][amount]" value="365"> <label class="option" for="edit-submitted-donation-amount-3">$365.00 </label>
          </div>
          <div class="form-item form-type-radio form-item-submitted-donation-amount control-group">
            <input type="radio" id="edit-submitted-donation-amount-4" name="submitted[donation][amount]" value="500"> <label class="option" for="edit-submitted-donation-amount-4">$500.00 </label>
          </div>
          <div class="form-item form-type-radio form-item-submitted-donation-amount control-group">
            <input type="radio" id="edit-submitted-donation-amount-5" name="submitted[donation][amount]" value="1200"> <label class="option" for="edit-submitted-donation-amount-5">$1,200.00 </label>
          </div>
          <div class="form-item form-type-radio form-item-submitted-donation-amount control-group other">
            <input type="radio" id="edit-submitted-donation-amount-6" name="submitted[donation][amount]" value="other"> <label class="option" for="edit-submitted-donation-amount-6">Other </label>
          </div>
        </div>
      </div>
      <div class="form-item webform-component webform-component-textfield control-group" id="webform-component-donation--other-amount" style="display: none;">
        <label for="edit-submitted-donation-other-amount">Other </label>
        <div class="field-prefix">$</div><input class="input-medium form-text other-field" type="text" id="edit-submitted-donation-other-amount" name="submitted[donation][other_amount]" value="" size="10" maxlength="128">
        <div class="description">(minimum $5.00)</div>
      </div>
      <div class="form-item webform-component webform-component-textfield control-group" id="webform-component-donation--recurring-other-amount">
        <label for="edit-submitted-donation-recurring-other-amount">Other Monthly Amount </label>
        <div class="field-prefix">$</div><input class="input-medium form-text other-field" type="text" id="edit-submitted-donation-recurring-other-amount" name="submitted[donation][recurring_other_amount]" value="" size="10" maxlength="128">
        <div class="description">(minimum $5.00)</div>
      </div>
    </div>
  </fieldset>
  <fieldset class="webform-component-fieldset form-wrapper" id="webform-component-donor-information">
    <legend><span class="fieldset-legend">Your Information</span></legend>
    <div class="fieldset-wrapper">
      <div class="form-item webform-component webform-component-textfield control-group" id="webform-component-donor-information--first-name">
        <label for="edit-submitted-donor-information-first-name">First Name <span class="form-required" title="This field is required.">*</span></label>
        <input type="text" id="edit-submitted-donor-information-first-name" name="submitted[donor_information][first_name]" value="" size="60" maxlength="128" class="form-text required">
      </div>
      <div class="form-item webform-component webform-component-textfield control-group" id="webform-component-donor-information--last-name">
        <label for="edit-submitted-donor-information-last-name">Last Name <span class="form-required" title="This field is required.">*</span></label>
        <input type="text" id="edit-submitted-donor-information-last-name" name="submitted[donor_information][last_name]" value="" size="60" maxlength="128" class="form-text required">
      </div>
      <div class="form-item webform-component webform-component-email control-group" id="webform-component-donor-information--mail">
        <label for="edit-submitted-donor-information-mail">E-mail address <span class="form-required" title="This field is required.">*</span></label>
        <input class="email form-text form-email required" type="email" id="edit-submitted-donor-information-mail" name="submitted[donor_information][mail]" size="60">
      </div>
    </div>
  </fieldset>
  <fieldset class="webform-component-fieldset form-wrapper" id="webform-component-billing-information">
    <div class="fieldset-wrapper">
      <div class="form-item webform-component webform-component-select control-group" id="webform-component-billing-information--country">
        <label for="edit-submitted-billing-information-country">Country <span class="form-required" title="This field is required.">*</span></label>
        <div class="select-wrapper"><select id="edit-submitted-billing-information-country" name="submitted[billing_information][country]" class="form-select required ajax-processed">
            <option value="CA">Canada</option>
            <option value="US" selected="selected">United States</option>
          </select></div>
      </div>
      <div class="form-item webform-component webform-component-textfield control-group" id="webform-component-billing-information--address">
        <label for="edit-submitted-billing-information-address">Address <span class="form-required" title="This field is required.">*</span></label>
        <input type="text" id="edit-submitted-billing-information-address" name="submitted[billing_information][address]" value="" size="60" maxlength="128" class="form-text required">
      </div>
      <div class="form-item webform-component webform-component-textfield control-group" id="webform-component-billing-information--address-line-2">
        <label for="edit-submitted-billing-information-address-line-2">Address Line 2 </label>
        <input type="text" id="edit-submitted-billing-information-address-line-2" name="submitted[billing_information][address_line_2]" value="" size="60" maxlength="128" class="form-text">
      </div>
      <div class="form-item webform-component webform-component-textfield control-group" id="webform-component-billing-information--city">
        <label for="edit-submitted-billing-information-city">City <span class="form-required" title="This field is required.">*</span></label>
        <input type="text" id="edit-submitted-billing-information-city" name="submitted[billing_information][city]" value="" size="60" maxlength="128" class="form-text required">
      </div>
      <div id="zone-select-wrapper">
        <div class="form-item webform-component webform-component-select control-group" id="webform-component-billing-information--state">
          <label for="edit-submitted-billing-information-state">State/Province <span class="form-required" title="This field is required.">*</span></label>
          <div class="select-wrapper"><select id="edit-submitted-billing-information-state" name="submitted[billing_information][state]" class="form-select required">
              <option value="" selected="selected">- Select -</option>
              <option value="AL">Alabama</option>
              <option value="AK">Alaska</option>
              <option value="AZ">Arizona</option>
              <option value="AR">Arkansas</option>
              <option value="CA">California</option>
              <option value="CO">Colorado</option>
              <option value="CT">Connecticut</option>
              <option value="DE">Delaware</option>
              <option value="DC">District of Columbia</option>
              <option value="FL">Florida</option>
              <option value="GA">Georgia</option>
              <option value="HI">Hawaii</option>
              <option value="ID">Idaho</option>
              <option value="IL">Illinois</option>
              <option value="IN">Indiana</option>
              <option value="IA">Iowa</option>
              <option value="KS">Kansas</option>
              <option value="KY">Kentucky</option>
              <option value="LA">Louisiana</option>
              <option value="ME">Maine</option>
              <option value="MD">Maryland</option>
              <option value="MA">Massachusetts</option>
              <option value="MI">Michigan</option>
              <option value="MN">Minnesota</option>
              <option value="MS">Mississippi</option>
              <option value="MO">Missouri</option>
              <option value="MT">Montana</option>
              <option value="NE">Nebraska</option>
              <option value="NV">Nevada</option>
              <option value="NH">New Hampshire</option>
              <option value="NJ">New Jersey</option>
              <option value="NM">New Mexico</option>
              <option value="NY">New York</option>
              <option value="NC">North Carolina</option>
              <option value="ND">North Dakota</option>
              <option value="OH">Ohio</option>
              <option value="OK">Oklahoma</option>
              <option value="OR">Oregon</option>
              <option value="PA">Pennsylvania</option>
              <option value="RI">Rhode Island</option>
              <option value="SC">South Carolina</option>
              <option value="SD">South Dakota</option>
              <option value="TN">Tennessee</option>
              <option value="TX">Texas</option>
              <option value="UT">Utah</option>
              <option value="VT">Vermont</option>
              <option value="VA">Virginia</option>
              <option value="WA">Washington</option>
              <option value="WV">West Virginia</option>
              <option value="WI">Wisconsin</option>
              <option value="WY">Wyoming</option>
              <option value=" ">--</option>
              <option value="AA">Armed Forces (Americas)</option>
              <option value="AE">Armed Forces (Europe, Canada, Middle East, Africa)</option>
              <option value="AP">Armed Forces (Pacific)</option>
              <option value="AS">American Samoa</option>
              <option value="FM">Federated States of Micronesia</option>
              <option value="GU">Guam</option>
              <option value="MH">Marshall Islands</option>
              <option value="MP">Northern Mariana Islands</option>
              <option value="PW">Palau</option>
              <option value="PR">Puerto Rico</option>
              <option value="VI">Virgin Islands</option>
            </select></div>
        </div>
      </div>
      <div class="form-item webform-component webform-component-textfield control-group" id="webform-component-billing-information--zip">
        <label for="edit-submitted-billing-information-zip">ZIP/Postal Code <span class="form-required" title="This field is required.">*</span></label>
        <input class="input-medium form-text required" type="text" id="edit-submitted-billing-information-zip" name="submitted[billing_information][zip]" value="" size="10" maxlength="10">
      </div>
      <div class="form-item webform-component webform-component-textfield control-group" id="webform-component-billing-information--phone-number">
        <label for="edit-submitted-billing-information-phone-number">Phone Number </label>
        <input type="text" id="edit-submitted-billing-information-phone-number" name="submitted[billing_information][phone_number]" value="" size="60" maxlength="128" class="form-text">
      </div>
    </div>
  </fieldset>
  <fieldset class="webform-component-fieldset form-wrapper" id="webform-component-payment-information">
    <legend><span class="fieldset-legend">Payment Details</span></legend>
    <div class="fieldset-wrapper">
      <fieldset class="webform-component-fieldset form-wrapper" id="webform-component-payment-information--auth-wrapper" style="display: block;">
        <div class="fieldset-wrapper">
          <div class="form-item webform-component webform-component-markup control-group" id="webform-component-payment-information--auth-wrapper--payment-authorization">
            <h4>Checking Account or Credit Card Authorization</h4>
            <p>I authorize Blue Ridge Public Radio to deduct my Sustaining donation from the bank account or credit card submitted on this form. The first deduction will occur on or shortly after today's date and continue until I notify BPR that I
              wish to change or end this agreement. BPR can be reached by phone at (828) 210-4800 or by email at donate@bpr.org.</p>
          </div>
          <div class="form-item webform-component webform-component-checkboxes control-group" id="webform-component-payment-information--auth-wrapper--sustainer-authorization">
            <div id="edit-submitted-payment-information-auth-wrapper-sustainer-authorization">
              <div class="form-item form-type-checkbox form-item-submitted-payment-information-auth-wrapper-sustainer-authorization-Acknowledged control-group">
                <input type="checkbox" id="edit-submitted-payment-information-auth-wrapper-sustainer-authorization-1" name="submitted[payment_information][auth_wrapper][sustainer_authorization][Acknowledged]" value="Acknowledged"
                  class="form-checkbox"> <label class="option" for="edit-submitted-payment-information-auth-wrapper-sustainer-authorization-1">I agree. </label>
              </div>
            </div>
          </div>
        </div>
      </fieldset>
      <div class="form-item webform-component webform-component-radios control-group" id="webform-component-payment-information--payment-method">
        <label for="edit-submitted-payment-information-payment-method">Payment Method <span class="form-required" title="This field is required.">*</span></label>
        <div id="edit-submitted-payment-information-payment-method">
          <div class="form-item form-type-radio form-item-submitted-payment-information-payment-method control-group credit">
            <input class="fundraiser-payment-methods" type="radio" id="edit-submitted-payment-information-payment-method-1" name="submitted[payment_information][payment_method]" value="credit" checked="checked"> <label class="option"
              for="edit-submitted-payment-information-payment-method-1">Credit Card </label>
          </div>
          <div class="form-item form-type-radio form-item-submitted-payment-information-payment-method control-group bank-account" style="display: block;">
            <input class="fundraiser-payment-methods" type="radio" id="edit-submitted-payment-information-payment-method-2" name="submitted[payment_information][payment_method]" value="bank account"> <label class="option"
              for="edit-submitted-payment-information-payment-method-2">Checking Account </label>
          </div>
        </div>
      </div>
      <div class="webform-component-fieldset form-wrapper" id="webform-component-payment-information--payment-fields">
        <fieldset class="fundraiser-payment-fields form-wrapper" id="edit-submitted-payment-information-payment-fields-credit">
          <div class="fieldset-wrapper">
            <div class="form-item form-type-textfield form-item-submitted-payment-information-payment-fields-credit-card-number control-group">
              <label for="edit-submitted-payment-information-payment-fields-credit-card-number">Credit card number <span class="form-required">*</span></label>
              <input class="input-large form-text" autocomplete="off" type="text" id="edit-submitted-payment-information-payment-fields-credit-card-number" name="submitted[payment_information][payment_fields][credit][card_number]" value="" size="20"
                maxlength="128">
            </div>
            <div class="expiration-date-wrapper clear-block">
              <div class="form-item form-type-select form-item-submitted-payment-information-payment-fields-credit-expiration-date-card-expiration-month control-group">
                <label for="edit-submitted-payment-information-payment-fields-credit-expiration-date-card-expiration-month">Expiration date <span class="form-required">*</span></label>
                <div class="select-wrapper"><select class="input-small form-select" id="edit-submitted-payment-information-payment-fields-credit-expiration-date-card-expiration-month"
                    name="submitted[payment_information][payment_fields][credit][expiration_date][card_expiration_month]">
                    <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" selected="selected">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></div>
                <div class="select-wrapper"><select class="input-small form-select" id="edit-submitted-payment-information-payment-fields-credit-expiration-date-card-expiration-year"
                    name="submitted[payment_information][payment_fields][credit][expiration_date][card_expiration_year]">
                    <option value="2024" selected="selected">2024</option>
                    <option value="2025">2025</option>
                    <option value="2026">2026</option>
                    <option value="2027">2027</option>
                    <option value="2028">2028</option>
                    <option value="2029">2029</option>
                    <option value="2030">2030</option>
                    <option value="2031">2031</option>
                    <option value="2032">2032</option>
                    <option value="2033">2033</option>
                    <option value="2034">2034</option>
                    <option value="2035">2035</option>
                    <option value="2036">2036</option>
                    <option value="2037">2037</option>
                    <option value="2038">2038</option>
                    <option value="2039">2039</option>
                  </select></div>
              </div>
            </div>
            <div class="form-item form-type-textfield form-item-submitted-payment-information-payment-fields-credit-card-cvv control-group">
              <label for="edit-submitted-payment-information-payment-fields-credit-card-cvv">Security Code <span class="form-required">*</span></label>
              <input class="input-small form-text" autocomplete="off" type="text" id="edit-submitted-payment-information-payment-fields-credit-card-cvv" name="submitted[payment_information][payment_fields][credit][card_cvv]" value="" size="6"
                maxlength="128">
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