CINXE.COM
MAKE A BIGGER IMPACT
<!DOCTYPE HTML> <html lang="en-US"> <head> <title>MAKE A BIGGER IMPACT</title> <meta name="viewport" content="width=device-width, initial-scale=1.0" /> <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <meta name="referrer" content="no-referrer-when-downgrade"> <!-- THIS SCRIPT NEEDS TO BE LOADED FIRST BEFORE wforms.js --> <script type="text/javascript" data-for="FA__DOMContentLoadedEventDispatch" src="https://www.tfaforms.com/js/FA__DOMContentLoadedEventDispatcher.js" defer></script> <style> .captcha { padding-bottom: 1em !important; } .wForm .captcha .oneField { margin: 0; padding: 0; } </style> <script type="text/javascript"> // initialize our variables var captchaReady = 0; var wFORMSReady = 0; var isConditionalSubmitEnabled = false; // when wForms is loaded call this var wformsReadyCallback = function () { // using this var to denote if wForms is loaded wFORMSReady = 1; isConditionalSubmitEnabled = document.getElementById('submit_button').hasAttribute('data-condition'); // call our recaptcha function which is dependent on both // wForms and an async call to google // note the meat of this function wont fire until both // wFORMSReady = 1 and captchaReady = 1 onloadCallback(); } var gCaptchaReadyCallback = function() { // using this var to denote if captcha is loaded captchaReady = 1; isConditionalSubmitEnabled = document.getElementById('submit_button').hasAttribute('data-condition'); // call our recaptcha function which is dependent on both // wForms and an async call to google // note the meat of this function wont fire until both // wFORMSReady = 1 and captchaReady = 1 onloadCallback(); }; // add event listener to fire when wForms is fully loaded document.addEventListener("wFORMSLoaded", wformsReadyCallback); var enableSubmitButton = function() { var submitButton = document.getElementById('submit_button'); var explanation = document.getElementById('disabled-explanation'); var isConditionalSubmitConditionMet = wFORMS.behaviors.condition.isConditionalSubmitConditionMet; if ( submitButton != null && (isConditionalSubmitEnabled && isConditionalSubmitConditionMet) || !isConditionalSubmitEnabled ) { submitButton.removeAttribute('disabled'); if (explanation != null) { explanation.style.display = 'none'; } } }; var disableSubmitButton = function() { var submitButton = document.getElementById('submit_button'); var explanation = document.getElementById('disabled-explanation'); if (submitButton != null) { submitButton.disabled = true; if (explanation != null) { explanation.style.display = 'block'; } } }; // call this on both captcha async complete and wforms fully // initialized since we can't be sure which will complete first // and we need both done for this to function just check that they are // done to fire the functionality var onloadCallback = function () { // if our captcha is ready (async call completed) // and wFORMS is completely loaded then we are ready to add // the captcha to the page if (captchaReady && wFORMSReady) { grecaptcha.enterprise.render('g-recaptcha-render-div', { 'sitekey': '6LfMg_EaAAAAAMhDNLMlgqDChzmtYHlx1yU2y7GI', 'theme': 'light', 'size': 'normal', 'callback': 'enableSubmitButton', 'expired-callback': 'disableSubmitButton' }) var oldRecaptchaCheck = parseInt('1'); if (oldRecaptchaCheck === -1) { var standardCaptcha = document.getElementById("tfa_captcha_text"); standardCaptcha = standardCaptcha.parentNode.parentNode.parentNode; standardCaptcha.parentNode.removeChild(standardCaptcha); } if (!wFORMS.instances['paging']) { document.getElementById("g-recaptcha-render-div").parentNode.parentNode.parentNode.style.display = "block"; //document.getElementById("g-recaptcha-render-div").parentNode.parentNode.parentNode.removeAttribute("hidden"); } document.getElementById("g-recaptcha-render-div").getAttributeNode('id').value = 'tfa_captcha_text'; var captchaError = ''; if (captchaError == '1') { var errMsgText = 'The CAPTCHA was not completed successfully.'; var errMsgDiv = document.createElement('div'); errMsgDiv.id = "tfa_captcha_text-E"; errMsgDiv.className = "err errMsg"; errMsgDiv.innerText = errMsgText; var loc = document.querySelector('.g-captcha-error'); loc.insertBefore(errMsgDiv, loc.childNodes[0]); /* See wFORMS.behaviors.paging.applyTo for origin of this code */ if (wFORMS.instances['paging']) { var b = wFORMS.instances['paging'][0]; var pp = base2.DOM.Element.querySelector(document, wFORMS.behaviors.paging.CAPTCHA_ERROR); if (pp) { var lastPage = 1; for (var i = 1; i < 100; i++) { if (b.behavior.isLastPageIndex(i)) { lastPage = i; break; } } b.jumpTo(lastPage); } } } } } </script> <script src='https://www.google.com/recaptcha/enterprise.js?onload=gCaptchaReadyCallback&render=explicit&hl=en_US' async defer></script> <script type="text/javascript"> document.addEventListener("DOMContentLoaded", function() { var warning = document.getElementById("javascript-warning"); if (warning != null) { warning.parentNode.removeChild(warning); } var oldRecaptchaCheck = parseInt('1'); if (oldRecaptchaCheck !== -1) { var explanation = document.getElementById('disabled-explanation'); var submitButton = document.getElementById('submit_button'); if (submitButton != null) { submitButton.disabled = true; if (explanation != null) { explanation.style.display = 'block'; } } } }); </script> <script type="text/javascript"> document.addEventListener("FA__DOMContentLoaded", function(){ const FORM_TIME_START = Math.floor((new Date).getTime()/1000); let formElement = document.getElementById("tfa_0"); if (null === formElement) { formElement = document.getElementById("0"); } let appendJsTimerElement = function(){ let formTimeDiff = Math.floor((new Date).getTime()/1000) - FORM_TIME_START; let cumulatedTimeElement = document.getElementById("tfa_dbCumulatedTime"); if (null !== cumulatedTimeElement) { let cumulatedTime = parseInt(cumulatedTimeElement.value); if (null !== cumulatedTime && cumulatedTime > 0) { formTimeDiff += cumulatedTime; } } let jsTimeInput = document.createElement("input"); jsTimeInput.setAttribute("type", "hidden"); jsTimeInput.setAttribute("value", formTimeDiff.toString()); jsTimeInput.setAttribute("name", "tfa_dbElapsedJsTime"); jsTimeInput.setAttribute("id", "tfa_dbElapsedJsTime"); jsTimeInput.setAttribute("autocomplete", "off"); if (null !== formElement) { formElement.appendChild(jsTimeInput); } }; if (null !== formElement) { if(formElement.addEventListener){ formElement.addEventListener('submit', appendJsTimerElement, false); } else if(formElement.attachEvent){ formElement.attachEvent('onsubmit', appendJsTimerElement); } } }); </script> <link href="https://www.tfaforms.com/dist/form-builder/5.0.0/wforms-layout.css?v=1732688374" rel="stylesheet" type="text/css" /> <link href="https://www.tfaforms.com/uploads/themes/theme-71872.css" rel="stylesheet" type="text/css" /> <link href="https://www.tfaforms.com/dist/form-builder/5.0.0/wforms-jsonly.css?v=1732688374" rel="alternate stylesheet" title="This stylesheet activated by javascript" type="text/css" /> <script type="text/javascript" src="https://www.tfaforms.com/wForms/3.11/js/wforms.js?v=1732688374"></script> <script type="text/javascript"> if(wFORMS.behaviors.prefill) wFORMS.behaviors.prefill.skip = true; </script> <script type="text/javascript" src="https://www.tfaforms.com/wForms/3.11/js/localization-en_US.js?v=1732688374"></script> <script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f); 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} .wForm .wfPagingButtons, .wForm .actions { width: 100% !important; text-align: center; } #primaryAction { padding: 20px 100px 20px 100px; font-size: 16px; } .divTable{ display: table; width: 100%; } .divTableRow { display: table-row; } .divTableHeading { background-color: #EEE; display: table-header-group; } .divTableCell, .divTableHead { border: 0px solid #999999; display: table-cell; vertical-align: top; } .divTableBody { display: table-row-group; } </style> </div> <h3 class="wFormTitle" data-testid="form-title" id="4856707-T">MAKE A BIGGER IMPACT</h3> <form method="post" action="https://www.tfaforms.com/api_v2/workflow/processor" class="hintsTooltip labelsLeftAligned" id="4856707"> <div class="htmlSection" id="tfa_2618"><div class="htmlContent" id="tfa_2618-HTML"><div class="divTableRow"> <div style="padding-right:10px;" class="divTableCell"> <p class="MsoNormal"><strong><span style="font-size: 11.5pt; line-height: 107%; font-family: Montserrat; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial;">Your generous donation helps us build a coalition of inspired women who believe that we are stronger together.</span></strong></p><p class="MsoNormal"><strong><span style="font-size: 11.5pt; line-height: 107%; font-family: Montserrat; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial;"><br></span></strong></p> <p style="margin-bottom: 20px; line-height: 1.5em;"><span style="font-size: 15px;">Since we were founded in 2003, Impact Austin has granted over $8.84 million dollars to Central Texas nonprofits. That's over 126 grants representing 98 different organizations.</span></p><p style="margin-bottom: 20px; line-height: 1.5em;"><span style="font-size: 15px;">Use the form below make a donation or mail a check to P.O. Box 28148, Austin, TX 78755. </span></p><p style="margin-bottom: 20px; line-height: 1.5em; font-size: 15px;"><span style="font-size: 15px;">At Impact Austin, we're dedicated to helping women achieve their full philanthropic capacity. An easy way to double your contribution is through employee giving programs. Search your company </span><a target="_blank" href="https://doublethedonation.com/impactaustin" style="background-color: rgb(255, 255, 255);"><span style="font-weight: 700;">here</span></a><span style="font-size: 15px;"> to find links to Matching Gift Forms and other Guidelines. </span></p><p class="MsoNormal"><span style="font-size: 11.5pt; line-height: 107%; font-family: Montserrat; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial;">Interested in joining as a member? Please use our <a target="_blank" href="https://www.impactaustin.org/join-or-renew">membership form</a></span><span style="font-size: 11.5pt; line-height: 107%; font-family: Montserrat; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial;">. All contributions are tax deductible.</span></p><p class="MsoNormal"><span style="font-size: 11.5pt; line-height: 107%; font-family: Montserrat; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial;"><br></span></p><p style="margin-bottom: 20px; line-height: 1.5em; font-size: 15px;"><br></p> </div> <div class="divTableCell"><img style="max-width: 100%;float:right;" alt="Impact Austin graph of total impact" src="https://www.tfaforms.com/forms/get_image/216226/04JpoZTLn7zUuYPy74Q6b4A6iuMdSUoz1Vziy1GHwNUjEXFv3kVTZjE1KwoxRfzo-UPDATEDMAY2024.png"> </div> </div> </div></div> <input type="hidden" id="tfa_2289" name="tfa_2289" value="" class="calc-pid"><input type="hidden" id="tfa_2577" name="tfa_2577" value="" class="formula=todaysDate();"><div id="tfa_2317" class="section group"> <label class="label preField" id="tfa_2317-L"><h2 style="margin-top: 0px; margin-bottom: 25px; box-sizing: inherit; font-size: 24px; color: rgb(74, 74, 74); font-family: "open sans", Arial, Helvetica, sans-serif;" data-sc-ctx-bind="build.titleText()" class="donation-subtitle">Select a donation amount</h2></label><div id="tfa_2400" class="section inline group"> <div class="oneField field-container-D labelsRemoved " id="tfa_2305-D" role="radiogroup" aria-labelledby="tfa_2305-L" data-tfa-labelledby="-L tfa_2305-L"><div class="inputWrapper"><span id="tfa_2305" class="choices horizontal required"><span class="oneChoice maskControl"><input type="radio" value="tfa_2358" class="calc-MEMOPT calcval-MONTHLY" id="tfa_2358" name="tfa_2305" aria-required="true" data-conditionals="#tfa_2485,#tfa_2349,#tfa_2519" aria-labelledby="tfa_2358-L" data-tfa-labelledby="tfa_2305-L tfa_2358-L" data-tfa-parent-id="tfa_2305"><label class="label postField" id="tfa_2358-L" for="tfa_2358"><span class="input-radio-faux"></span><b>Monthly<br></b></label></span><span class="oneChoice maskControl"><input type="radio" value="tfa_2307" class="calc-MEMOPT calcval-ONETIME" checked data-default-value="true" id="tfa_2307" name="tfa_2305" aria-required="true" data-conditionals="#tfa_2318,#tfa_2499,#tfa_2350" aria-labelledby="tfa_2307-L" data-tfa-labelledby="tfa_2305-L tfa_2307-L" data-tfa-parent-id="tfa_2305"><label class="label postField" id="tfa_2307-L" for="tfa_2307"><span class="input-radio-faux"></span><b>One Time</b></label></span></span></div></div> <div class="oneField field-container-D labelsRemoved " id="tfa_2485-D" role="radiogroup" aria-labelledby="tfa_2485-L" data-tfa-labelledby="-L tfa_2485-L"><div class="inputWrapper"><span id="tfa_2485" class="choices horizontal required" data-condition="`#tfa_2358`"><span class="oneChoice maskControl"><input type="radio" value="tfa_2486" class="calc-PRICE calcval-20" id="tfa_2486" name="tfa_2485" aria-required="true" data-conditionals="#tfa_2383" aria-labelledby="tfa_2486-L" data-tfa-labelledby="tfa_2485-L tfa_2486-L" data-tfa-parent-id="tfa_2485"><label class="label postField" id="tfa_2486-L" for="tfa_2486"><span class="input-radio-faux"></span>$20</label></span><span class="oneChoice maskControl"><input type="radio" value="tfa_2487" class="calc-PRICE calcval-40" checked data-default-value="true" id="tfa_2487" name="tfa_2485" aria-required="true" data-conditionals="#tfa_2386" aria-labelledby="tfa_2487-L" data-tfa-labelledby="tfa_2485-L tfa_2487-L" data-tfa-parent-id="tfa_2485"><label class="label postField" id="tfa_2487-L" for="tfa_2487"><span class="input-radio-faux"></span>$40</label></span><span class="oneChoice maskControl"><input type="radio" value="tfa_2488" class="calc-PRICE calcval-80" id="tfa_2488" name="tfa_2485" aria-required="true" data-conditionals="#tfa_2390" aria-labelledby="tfa_2488-L" data-tfa-labelledby="tfa_2485-L tfa_2488-L" data-tfa-parent-id="tfa_2485"><label class="label postField" id="tfa_2488-L" for="tfa_2488"><span class="input-radio-faux"></span>$80</label></span><span class="oneChoice maskControl"><input type="radio" value="tfa_2489" class="calc-PRICE calcval-200" id="tfa_2489" name="tfa_2485" aria-required="true" data-conditionals="#tfa_2394" aria-labelledby="tfa_2489-L" data-tfa-labelledby="tfa_2485-L tfa_2489-L" data-tfa-parent-id="tfa_2485"><label class="label postField" id="tfa_2489-L" for="tfa_2489"><span class="input-radio-faux"></span>$200</label></span><span class="oneChoice maskControl"><input type="radio" value="tfa_2490" class="calc-PRICE calcval-400" id="tfa_2490" name="tfa_2485" aria-required="true" data-conditionals="#tfa_2398" aria-labelledby="tfa_2490-L" data-tfa-labelledby="tfa_2485-L tfa_2490-L" data-tfa-parent-id="tfa_2485"><label class="label postField" id="tfa_2490-L" for="tfa_2490"><span class="input-radio-faux"></span>$400</label></span><span class="oneChoice maskControl"><input type="radio" value="tfa_2491" class="calc-PRICE calcval-0" id="tfa_2491" name="tfa_2485" aria-required="true" data-conditionals="#tfa_2373" aria-labelledby="tfa_2491-L" data-tfa-labelledby="tfa_2485-L tfa_2491-L" data-tfa-parent-id="tfa_2485"><label class="label postField" id="tfa_2491-L" for="tfa_2491"><span class="input-radio-faux"></span>Other</label></span></span></div></div> <div class="oneField field-container-D labelsRemoved " id="tfa_2318-D" role="radiogroup" aria-labelledby="tfa_2318-L" data-tfa-labelledby="-L tfa_2318-L"><div class="inputWrapper"><span id="tfa_2318" class="choices horizontal required" data-condition="`#tfa_2307`"><span class="oneChoice maskControl"><input type="radio" value="tfa_2319" class="calc-PRICE calcval-250" id="tfa_2319" name="tfa_2318" aria-required="true" data-conditionals="#tfa_2383" aria-labelledby="tfa_2319-L" data-tfa-labelledby="tfa_2318-L tfa_2319-L" data-tfa-parent-id="tfa_2318"><label class="label postField" id="tfa_2319-L" for="tfa_2319"><span class="input-radio-faux"></span>$250</label></span><span class="oneChoice maskControl"><input type="radio" value="tfa_2320" class="calc-PRICE calcval-500" checked data-default-value="true" id="tfa_2320" name="tfa_2318" aria-required="true" data-conditionals="#tfa_2386" aria-labelledby="tfa_2320-L" data-tfa-labelledby="tfa_2318-L tfa_2320-L" data-tfa-parent-id="tfa_2318"><label class="label postField" id="tfa_2320-L" for="tfa_2320"><span class="input-radio-faux"></span>$500</label></span><span class="oneChoice maskControl"><input type="radio" value="tfa_2321" class="calc-PRICE calcval-1000" id="tfa_2321" name="tfa_2318" aria-required="true" data-conditionals="#tfa_2390" aria-labelledby="tfa_2321-L" data-tfa-labelledby="tfa_2318-L tfa_2321-L" data-tfa-parent-id="tfa_2318"><label class="label postField" id="tfa_2321-L" for="tfa_2321"><span class="input-radio-faux"></span>$1,000</label></span><span class="oneChoice maskControl"><input type="radio" value="tfa_2369" class="calc-PRICE calcval-2500" id="tfa_2369" name="tfa_2318" aria-required="true" data-conditionals="#tfa_2394" aria-labelledby="tfa_2369-L" data-tfa-labelledby="tfa_2318-L tfa_2369-L" data-tfa-parent-id="tfa_2318"><label class="label postField" id="tfa_2369-L" for="tfa_2369"><span class="input-radio-faux"></span>$2,500</label></span><span class="oneChoice maskControl"><input type="radio" value="tfa_2370" class="calc-PRICE calcval-5000" id="tfa_2370" name="tfa_2318" aria-required="true" data-conditionals="#tfa_2398" aria-labelledby="tfa_2370-L" data-tfa-labelledby="tfa_2318-L tfa_2370-L" data-tfa-parent-id="tfa_2318"><label class="label postField" id="tfa_2370-L" for="tfa_2370"><span class="input-radio-faux"></span>$5,000</label></span><span class="oneChoice maskControl"><input type="radio" value="tfa_2371" class="calc-PRICE calcval-0" id="tfa_2371" name="tfa_2318" aria-required="true" data-conditionals="#tfa_2373" aria-labelledby="tfa_2371-L" data-tfa-labelledby="tfa_2318-L tfa_2371-L" data-tfa-parent-id="tfa_2318"><label class="label postField" id="tfa_2371-L" for="tfa_2371"><span class="input-radio-faux"></span>Other</label></span></span></div></div> <div class="oneField field-container-D labelsRightAligned " id="tfa_2373-D"> <label id="tfa_2373-L" class="label preField " for="tfa_2373"><b>Other amount:</b></label><div class="inputWrapper"> <div class="delimiter delimiterBefore" id="tfa_2373-DB">$</div> <input type="text" id="tfa_2373" name="tfa_2373" value="" aria-describedby="tfa_2373-HH" min="10" data-condition="`#tfa_2491` OR `#tfa_2371`" title="Other amount:" class="validate-float calc-PRICE"><div class="delimiter delimiterAfter" id="tfa_2373-DA"> </div> <span class="field-hint-inactive" id="tfa_2373-H"><span id="tfa_2373-HH" class="hint">Minimum of $10. Whole numbers only please (e.g. 10)</span></span> </div> </div> <div id="tfa_2383" class="section group" data-condition="`#tfa_2319` OR `#tfa_2486`"><div class="htmlSection" id="tfa_2382"><div class="htmlContent" id="tfa_2382-HTML"><div style="width: 670px; display: table;"> <div style="display: table-cell; text-align: right;"><b>Friend </b><span style="font-weight: 700; font-size: 14.4px;">($250 </span><span style="font-weight: 700; font-size: 14.4px;"><small style="font-size: 11.52px;">annually</small></span><span style="font-weight: 700; font-size: 14.4px;">)</span></div> </div></div></div></div> <div id="tfa_2386" class="section group" data-condition="`#tfa_2320` OR `#tfa_2487`"><div class="htmlSection" id="tfa_2387"><div class="htmlContent" id="tfa_2387-HTML"><div style="width: 670px; display: table;"> <div style="display: table-cell; text-align: right;"><b>Saluting </b><span style="font-weight: 700; font-size: 14.4px;">($500 </span><span style="font-weight: 700; font-size: 14.4px;"><small style="font-size: 11.52px;">annually</small></span><span style="font-weight: 700; font-size: 14.4px;">)</span></div> </div> </div></div></div> <div id="tfa_2390" class="section group" data-condition="`#tfa_2321` OR `#tfa_2488`"><div class="htmlSection" id="tfa_2391"><div class="htmlContent" id="tfa_2391-HTML"><div style="width: 670px; display: table;"> <div style="display: table-cell; text-align: right;"><b>Celebrating </b><span style="font-weight: 700; font-size: 14.4px;">($1,000 </span><span style="font-weight: 700; font-size: 14.4px;"><small style="font-size: 11.52px;">annually</small></span><span style="font-weight: 700; font-size: 14.4px;">)</span></div> </div> </div></div></div> <div id="tfa_2394" class="section group" data-condition="`#tfa_2369` OR `#tfa_2489`"><div class="htmlSection" id="tfa_2395"><div class="htmlContent" id="tfa_2395-HTML"><div style="width: 670px; display: table;"> <div style="display: table-cell; text-align: right;"><b>Champion </b><span style="font-weight: 700; font-size: 14.4px;">($2,500 </span><span style="font-weight: 700; font-size: 14.4px;"><small style="font-size: 11.52px;">annually</small></span><span style="font-weight: 700; font-size: 14.4px;">)</span></div> </div> </div></div></div> <div id="tfa_2398" class="section inline group" data-condition="`#tfa_2370` OR `#tfa_2490`"><div class="htmlSection" id="tfa_2399"><div class="htmlContent" id="tfa_2399-HTML"><div style="width: 670px; display: table;"> <div style="display: table-cell; text-align: right;"><b>Empowerment </b><span style="font-weight: 700; font-size: 14.4px;">($5,000 </span><span style="font-weight: 700; font-size: 14.4px;"><small style="font-size: 11.52px;">annually</small></span><span style="font-weight: 700; font-size: 14.4px;">)</span></div> </div> </div></div></div> </div> <div class="oneField field-container-D labelsAbove " id="tfa_2599-D" role="radiogroup" aria-labelledby="tfa_2599-L" data-tfa-labelledby="-L tfa_2599-L"> <label id="tfa_2599-L" class="label preField " data-tfa-check-label-for="tfa_2599"><span style="font-weight: 700; font-size: 14.4px;">Direct my donation to<span style="color: rgb(0, 0, 0); font-family: "Trebuchet MS", Arial, Helvetica, sans-serif; font-size: 14px;">:</span></span></label><br><div class="inputWrapper"><table id="tfa_2599" class="choices columns2 "> <tr> <td><span class="oneChoice"><input type="radio" value="tfa_2616" class="calc-ALLOCATION calcval-701d0000000VHOeAAO" checked data-default-value="true" id="tfa_2616" name="tfa_2599" aria-labelledby="tfa_2616-L" data-tfa-labelledby="tfa_2599-L tfa_2616-L" data-tfa-parent-id="tfa_2599"><label class="label postField" id="tfa_2616-L" for="tfa_2616"><span class="input-radio-faux"></span>No Preference</label></span></td> <td><span class="oneChoice"><input type="radio" value="tfa_2600" class="calc-ALLOCATION calcval-701d0000000VHOeAAO" id="tfa_2600" name="tfa_2599" aria-labelledby="tfa_2600-L" data-tfa-labelledby="tfa_2599-L tfa_2600-L" data-tfa-parent-id="tfa_2599"><label class="label postField" id="tfa_2600-L" for="tfa_2600"><span class="input-radio-faux"></span>Annual Fund - <a target="_blank" href="https://www.impactaustin.org/philanthropy-circle">Philanthropy Circle</a> and Giving Tuesday</label></span></td> </tr> <tr> <td><span class="oneChoice"><input type="radio" value="tfa_2601" class="calc-ALLOCATION calcval-701d0000001ldvhAAA" id="tfa_2601" name="tfa_2599" aria-labelledby="tfa_2601-L" data-tfa-labelledby="tfa_2599-L tfa_2601-L" data-tfa-parent-id="tfa_2599"><label class="label postField" id="tfa_2601-L" for="tfa_2601"><span class="input-radio-faux"></span><a target="_blank" href="https://www.impactaustin.org/endowment">Rebecca Warren Powers Endowment</a></label></span></td> <td><span class="oneChoice"><input type="radio" value="tfa_2602" class="calc-ALLOCATION calcval-701d0000000VHOyAAO" id="tfa_2602" name="tfa_2599" aria-labelledby="tfa_2602-L" data-tfa-labelledby="tfa_2599-L tfa_2602-L" data-tfa-parent-id="tfa_2599"><label class="label postField" id="tfa_2602-L" for="tfa_2602"><span class="input-radio-faux"></span><span style="font-size: 14px;"><a target="_blank" href="https://www.impactaustin.org/girls-giving-grants">Girls Giving Grants</a></span></label></span></td> </tr> <tr> <td><span class="oneChoice"><input type="radio" value="tfa_2603" class="calc-ALLOCATION calcval-701d0000000VHP3AAO" id="tfa_2603" name="tfa_2599" aria-labelledby="tfa_2603-L" data-tfa-labelledby="tfa_2599-L tfa_2603-L" data-tfa-parent-id="tfa_2599"><label class="label postField" id="tfa_2603-L" for="tfa_2603"><span class="input-radio-faux"></span>Donna Eastman Impactship Fund</label></span></td> <td><span class="oneChoice"><input type="radio" value="tfa_2604" class="calc-ALLOCATION calcval-701d0000000VPu5AAG" id="tfa_2604" name="tfa_2599" aria-labelledby="tfa_2604-L" data-tfa-labelledby="tfa_2599-L tfa_2604-L" data-tfa-parent-id="tfa_2599"><label class="label postField" id="tfa_2604-L" for="tfa_2604"><span class="input-radio-faux"></span><a target="_blank" href="https://www.impactaustin.org/event-sponsorships">Event Sponsorship</a></label></span></td> </tr> </table></div> </div> <div class="htmlSection" id="tfa_2606"><div class="htmlContent" id="tfa_2606-HTML"><hr style="width:100%; padding:0px;margin:0px; border-top: 2px solid rgba(255,206,46,1);"></div></div> <div class="oneField field-container-D labelsRemoved " id="tfa_2585-D" role="group" aria-labelledby="tfa_2585-L" data-tfa-labelledby="-L tfa_2585-L"><div class="inputWrapper"><span id="tfa_2585" class="choices vertical "><span class="oneChoice"><input type="checkbox" value="tfa_2586" class="" id="tfa_2586" name="tfa_2586" aria-labelledby="tfa_2586-L" data-tfa-labelledby="tfa_2585-L tfa_2586-L" data-tfa-parent-id="tfa_2585"><label class="label postField" id="tfa_2586-L" for="tfa_2586"><span class="input-checkbox-faux"></span> Donate Anonymously</label></span></span></div></div> <div class="oneField field-container-D labelsRemoved " id="tfa_2492-D" role="group" aria-labelledby="tfa_2492-L" data-tfa-labelledby="-L tfa_2492-L"><div class="inputWrapper"><span id="tfa_2492" class="choices vertical "><span class="oneChoice"><input type="checkbox" value="tfa_2493" class="" id="tfa_2493" name="tfa_2493" data-conditionals="#tfa_2497" aria-labelledby="tfa_2493-L" data-tfa-labelledby="tfa_2492-L tfa_2493-L" data-tfa-parent-id="tfa_2492"><label class="label postField" id="tfa_2493-L" for="tfa_2493"><span class="input-checkbox-faux"></span><span style="color: rgb(16, 32, 51); font-family: "open sans", Arial, Helvetica, sans-serif; font-size: 13px;"> Dedicate my donation </span><span style="margin: 0px; padding: 0px; box-sizing: inherit; color: rgb(16, 32, 51); font-family: "open sans", Arial, Helvetica, sans-serif; font-size: 13px;" class="ng-scope">in honor or in memory</span><span style="color: rgb(16, 32, 51); font-family: "open sans", Arial, Helvetica, sans-serif; font-size: 13px;"> of someone</span></label></span></span></div></div> <div class="oneField field-container-D " id="tfa_2619-D"> <label id="tfa_2619-L" class="label preField " for="tfa_2619"><p data-pm-slice="1 1 ["list",{},"list_item",{"indent":1,"type":"bulleted"}]"><span style="font-family: proxima-n-w01-reg, sans-serif; font-size: 15px;">How would you like your name listed on recognition pages?</span></p></label><div class="inputWrapper"><input type="text" id="tfa_2619" name="tfa_2619" value="" title="How would you like your name listed on recognition pages?" class=""></div> </div> <div class="htmlSection" id="tfa_2511"><div class="htmlContent" id="tfa_2511-HTML"><hr style="width:100%; padding:0px;margin:0px; border-top: 2px solid rgba(255,206,46,1);"></div></div> <div id="tfa_2497" class="section group" data-condition="`#tfa_2493`"> <label class="label preField" id="tfa_2497-L"><h2 style="box-sizing: inherit; margin-top: 0px; margin-bottom: 25px; font-size: 24px; font-family: "open sans", Arial, Helvetica, sans-serif; vertical-align: top; color: rgb(74, 74, 74);" data-sc-ctx-bind="build.titleText()" class="donation-subtitle">in honor / memory</h2></label><div class="oneField field-container-D " id="tfa_2501-D"> <label id="tfa_2501-L" class="label preField reqMark" for="tfa_2501">Honoree First Name </label><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_2501" name="tfa_2501" value="" autocomplete="off" title="Honoree First Name " class="required"></div> </div> <div class="oneField field-container-D " id="tfa_2503-D"> <label id="tfa_2503-L" class="label preField reqMark" for="tfa_2503">Honoree Last Name</label><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_2503" name="tfa_2503" value="" autocomplete="off" title="Honoree Last Name" class="required"></div> </div> <div class="oneField field-container-D " id="tfa_2506-D"> <label id="tfa_2506-L" class="label preField reqMark" for="tfa_2506">Notification Recipient Name</label><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_2506" name="tfa_2506" value="" autocomplete="off" title="Notification Recipient Name" class="required"></div> </div> <div class="oneField field-container-D " id="tfa_2508-D"> <label id="tfa_2508-L" class="label preField reqMark" for="tfa_2508">Notification Recipient Email</label><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_2508" name="tfa_2508" value="" autocomplete="off" title="Notification Recipient Email" class="validate-email required"></div> </div> <div class="htmlSection" id="tfa_2513"><div class="htmlContent" id="tfa_2513-HTML"><hr style="width:100%; padding:0px;margin:0px; border-top: 2px solid rgba(255,206,46,1);"></div></div> </div> </div> <div id="tfa_1" class="section group"> <label class="label preField" id="tfa_1-L"><h2 style="margin-top: 0px; margin-bottom: 25px; box-sizing: inherit; font-size: 24px; color: rgb(74, 74, 74); font-family: "open sans", Arial, Helvetica, sans-serif;" data-sc-ctx-bind="build.titleText()" class="donation-subtitle">Your Information</h2></label><div id="tfa_2353" class="section inline group"> <div class="oneField field-container-D " id="tfa_1868-D"> <label id="tfa_1868-L" class="label preField reqMark" for="tfa_1868">First Name </label><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_1868" name="tfa_1868" value="" autocomplete="off" maxlength="40" title="First Name " class="required"></div> </div> <div class="oneField field-container-D " id="tfa_1869-D"> <label id="tfa_1869-L" class="label preField reqMark" for="tfa_1869">Last Name</label><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_1869" name="tfa_1869" value="" autocomplete="off" maxlength="80" title="Last Name" class="required"></div> </div> </div> <div id="tfa_2294" class="section inline group"> <div class="oneField field-container-D " id="tfa_1871-D"> <label id="tfa_1871-L" class="label preField reqMark" for="tfa_1871">Email</label><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_1871" name="tfa_1871" value="" autocomplete="off" title="Email" class="validate-email required"></div> </div> <div class="oneField field-container-D " id="tfa_2290-D"> <label id="tfa_2290-L" class="label preField reqMark" for="tfa_2290">Email Type</label><div class="inputWrapper"><select aria-required="true" id="tfa_2290" name="tfa_2290" title="Email Type" class="required"><option value="">Please select...</option> <option value="tfa_2291" id="tfa_2291" class="" selected data-default-value="true">Personal</option> <option value="tfa_2292" id="tfa_2292" class="">Work</option> <option value="tfa_2293" id="tfa_2293" class="">Other</option></select></div> </div> </div> <div id="tfa_2299" class="section inline group"> <div class="oneField field-container-D " id="tfa_1870-D"> <label id="tfa_1870-L" class="label preField reqMark" for="tfa_1870">Phone</label><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_1870" name="tfa_1870" value="" autocomplete="off" placeholder="###-###-####" autoformat="###-###-####" title="Phone" class="validate-custom /^([\(]{1}[0-9]{3}[\)]{1}[\.| |\-]{0,1}|^[0-9]{3}[\.|\-| ]?)?[0-9]{3}(\.|\-| )?[0-9]{4}$/ required"></div> </div> <div class="oneField field-container-D " id="tfa_2295-D"> <label id="tfa_2295-L" class="label preField reqMark" for="tfa_2295">Phone Type</label><div class="inputWrapper"><select aria-required="true" id="tfa_2295" name="tfa_2295" title="Phone Type" class="required"><option value="">Please select...</option> <option value="tfa_2296" id="tfa_2296" class="" selected data-default-value="true">Mobile</option> <option value="tfa_2297" id="tfa_2297" class="">Home</option> <option value="tfa_2298" id="tfa_2298" class="">Work</option> <option value="tfa_2300" id="tfa_2300" class="">Other</option></select></div> </div> </div> <div id="tfa_2199" class="section group"> <label class="label preField" id="tfa_2199-L"><b>Address</b></label><div id="tfa_2200" class="section inline group"> <div class="oneField field-container-D " id="tfa_1872-D"> <label id="tfa_1872-L" class="label preField reqMark" for="tfa_1872">Street Address</label><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_1872" name="tfa_1872" value="" autocomplete="off" title="Street Address" class="required"></div> </div> <div class="oneField field-container-D " id="tfa_1873-D"> <label id="tfa_1873-L" class="label preField " for="tfa_1873">Address Line 2</label><div class="inputWrapper"><input type="text" id="tfa_1873" name="tfa_1873" value="" placeholder="Suite / Apt No." title="Address Line 2" class=""></div> </div> <div class="oneField field-container-D labelsLeftAligned " id="tfa_1874-D"> <label id="tfa_1874-L" class="label preField reqMark" for="tfa_1874">City</label><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_1874" name="tfa_1874" value="" title="City" class="required"></div> </div> <div class="oneField field-container-D " id="tfa_2621-D"> <label id="tfa_2621-L" class="label preField reqMark" for="tfa_2621">State</label><div class="inputWrapper"><select aria-required="true" id="tfa_2621" name="tfa_2621" title="State" class="calc-states required"><option value="">Please select...</option> <option value="tfa_2622" id="tfa_2622" class="calcval-AL">AL</option> <option value="tfa_2623" id="tfa_2623" class="calcval-AK">AK</option> <option value="tfa_2624" id="tfa_2624" class="calcval-AZ">AZ</option> <option value="tfa_2625" id="tfa_2625" class="calcval-AR">AR</option> <option value="tfa_2626" id="tfa_2626" class="calcval-CA">CA</option> <option value="tfa_2627" id="tfa_2627" class="calcval-CO">CO</option> <option value="tfa_2628" id="tfa_2628" class="calcval-CT">CT</option> <option value="tfa_2629" id="tfa_2629" class="calcval-DE">DE</option> <option value="tfa_2630" id="tfa_2630" class="calcval-DC">DC</option> <option value="tfa_2631" id="tfa_2631" class="calcval-FL">FL</option> <option value="tfa_2632" id="tfa_2632" class="calcval-GA">GA</option> <option value="tfa_2633" id="tfa_2633" class="calcval-HI">HI</option> <option value="tfa_2634" id="tfa_2634" class="calcval-ID">ID</option> <option value="tfa_2635" id="tfa_2635" class="calcval-IL">IL</option> <option value="tfa_2636" id="tfa_2636" class="calcval-IN">IN</option> <option value="tfa_2637" id="tfa_2637" class="calcval-IA">IA</option> <option value="tfa_2638" id="tfa_2638" class="calcval-KS">KS</option> <option value="tfa_2639" id="tfa_2639" class="calcval-KY">KY</option> <option value="tfa_2640" id="tfa_2640" class="calcval-LA">LA</option> <option value="tfa_2641" id="tfa_2641" class="calcval-ME">ME</option> <option value="tfa_2642" id="tfa_2642" class="calcval-MD">MD</option> <option value="tfa_2643" id="tfa_2643" class="calcval-MA">MA</option> <option value="tfa_2644" id="tfa_2644" class="calcval-MI">MI</option> <option value="tfa_2645" id="tfa_2645" class="calcval-MN">MN</option> <option value="tfa_2646" id="tfa_2646" class="calcval-MS">MS</option> <option value="tfa_2647" id="tfa_2647" class="calcval-MO">MO</option> <option value="tfa_2648" id="tfa_2648" class="calcval-MT">MT</option> <option value="tfa_2649" id="tfa_2649" class="calcval-NE">NE</option> <option value="tfa_2650" id="tfa_2650" class="calcval-NV">NV</option> <option value="tfa_2651" id="tfa_2651" class="calcval-NH">NH</option> <option value="tfa_2652" id="tfa_2652" class="calcval-NJ">NJ</option> <option value="tfa_2653" id="tfa_2653" class="calcval-NM">NM</option> <option value="tfa_2654" id="tfa_2654" class="calcval-NY">NY</option> <option value="tfa_2655" id="tfa_2655" class="calcval-NC">NC</option> <option value="tfa_2656" id="tfa_2656" class="calcval-ND">ND</option> <option value="tfa_2657" id="tfa_2657" class="calcval-OH">OH</option> <option value="tfa_2658" id="tfa_2658" class="calcval-OK">OK</option> <option value="tfa_2659" id="tfa_2659" class="calcval-OR">OR</option> <option value="tfa_2660" id="tfa_2660" class="calcval-PA">PA</option> <option value="tfa_2661" id="tfa_2661" class="calcval-RI">RI</option> <option value="tfa_2662" id="tfa_2662" class="calcval-SC">SC</option> <option value="tfa_2663" id="tfa_2663" class="calcval-SD">SD</option> <option value="tfa_2664" id="tfa_2664" class="calcval-TN">TN</option> <option value="tfa_2665" id="tfa_2665" class="calcval-TX" selected data-default-value="true">TX</option> <option value="tfa_2666" id="tfa_2666" class="calcval-UT">UT</option> <option value="tfa_2667" id="tfa_2667" class="calcval-VT">VT</option> <option value="tfa_2668" id="tfa_2668" class="calcval-VA">VA</option> <option value="tfa_2669" id="tfa_2669" class="calcval-WA">WA</option> <option value="tfa_2670" id="tfa_2670" class="calcval-WV">WV</option> <option value="tfa_2671" id="tfa_2671" class="calcval-WI">WI</option> <option value="tfa_2672" id="tfa_2672" class="calcval-WY">WY</option></select></div> </div> <div class="oneField field-container-D " id="tfa_2186-D"> <label id="tfa_2186-L" class="label preField reqMark" for="tfa_2186">Zip Code</label><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_2186" name="tfa_2186" value="" title="Zip Code" class="validate-integer required"></div> </div> </div> </div> </div> <div class="htmlSection" id="tfa_2496"><div class="htmlContent" id="tfa_2496-HTML"><hr style="width:100%; padding:0px;margin:0px; border-top: 2px solid rgba(255,206,46,1);"></div></div> <div id="tfa_2347" class="section group"> <label class="label preField" id="tfa_2347-L"><h2 style="box-sizing: inherit; margin-top: 0px; margin-bottom: 25px; font-size: 24px; font-family: "open sans", Arial, Helvetica, sans-serif; vertical-align: top; color: rgb(74, 74, 74);" data-sc-ctx-bind="build.titleText()" class="donation-subtitle">Payment Details</h2></label><div class="oneField field-container-D labelsLeftAligned " id="tfa_2349-D"> <label id="tfa_2349-L" class="label preField reqMark" for="tfa_2349">Donation Amount</label><div class="inputWrapper"> <div class="delimiter delimiterBefore" id="tfa_2349-DB">$</div> <input aria-required="true" type="text" id="tfa_2349" name="tfa_2349" value="" readonly data-condition="`#tfa_2358`" title="Donation Amount" class="validate-float formula=PRICE.toFixed(0) calc-DONATION readonly required"><div class="delimiter delimiterAfter" id="tfa_2349-DA">per month</div> </div> </div> <div class="oneField field-container-D labelsLeftAligned " id="tfa_2499-D"> <label id="tfa_2499-L" class="label preField reqMark" for="tfa_2499">Donation Amount</label><div class="inputWrapper"> <div class="delimiter delimiterBefore" id="tfa_2499-DB">$</div> <input aria-required="true" type="text" id="tfa_2499" name="tfa_2499" value="" readonly data-condition="`#tfa_2307`" title="Donation Amount" class="validate-integer formula=PRICE.toFixed(0) calc-DONATION readonly required"><div class="delimiter delimiterAfter" id="tfa_2499-DA"> </div> </div> </div> <div class="oneField field-container-D labelsLeftAligned hintsTooltip " id="tfa_2338-D"> <label id="tfa_2338-L" class="label preField reqMark" for="tfa_2338">Credit Card Fees:</label><div class="inputWrapper"> <div class="delimiter delimiterBefore" id="tfa_2338-DB">$</div> <input aria-required="true" type="text" id="tfa_2338" name="tfa_2338" value="" readonly aria-describedby="tfa_2338-HH" title="Credit Card Fees:" class="validate-float formula=if(Math.round(DONATION*0.0291)<1){1}else{Math.round(DONATION*0.0291)} calc-FEES readonly required"><div class="delimiter delimiterAfter" id="tfa_2338-DA"> </div> <span class="field-hint-inactive" id="tfa_2338-H"><span id="tfa_2338-HH" class="hint">In order to process gifts made via credit card, Impact Austin works with a payment processor that charges us a required fee of 2.9% per gift.</span><button id="tfa_2338-HH-close-button" class="field-hint-close-button" type="button" tabindex="-1" aria-hidden="true" aria-label="Close"> x </button></span> </div> </div> <div class="oneField field-container-D labelsLeftAligned " id="tfa_2519-D"> <label id="tfa_2519-L" class="label preField " for="tfa_2519"><b>Total Due Today: </b></label><div class="inputWrapper"> <div class="delimiter delimiterBefore" id="tfa_2519-DB">$</div> <input type="text" id="tfa_2519" name="tfa_2519" value="" readonly data-condition="`#tfa_2358`" title="Total Due Today: " class="validate-integer formula=Math.round(DONATION+FEES) readonly"><div class="delimiter delimiterAfter" id="tfa_2519-DA">per month </div> </div> </div> <div class="oneField field-container-D labelsLeftAligned " id="tfa_2350-D"> <label id="tfa_2350-L" class="label preField " for="tfa_2350"><b>Total Due Today: </b></label><div class="inputWrapper"> <div class="delimiter delimiterBefore" id="tfa_2350-DB">$</div> <input type="text" id="tfa_2350" name="tfa_2350" value="" readonly data-condition="`#tfa_2307`" title="Total Due Today: " class="validate-integer formula=Math.round(DONATION+FEES) readonly"><div class="delimiter delimiterAfter" id="tfa_2350-DA"> </div> </div> </div> <div class="htmlSection" id="tfa_2515"><div class="htmlContent" id="tfa_2515-HTML"><hr style="width:100%; padding:0px;margin:0px; border-top: 2px solid rgba(255,206,46,1);"></div></div> </div> <div id="tfa_2242" class="section column group"> <label class="label preField" id="tfa_2242-L"><b>Credit Card</b></label><table class="columnLayout"><tbody><tr><td id="tfa_2245"> <div id="tfa_2610" class="section column group"><table class="columnLayout"> <tr> <td><div class="htmlSection" id="tfa_2416"><div class="htmlContent" id="tfa_2416-HTML"><img style="max-width: 100%;width: 200px;float:left;" alt="Credit Cards Accepted" src="//www.tfaforms.com/forms/get_image/216226/sfyzGlcBKl1fQocPgfdW22CjmE2AjYPVAyI1kbrskxLKKlu29F21B4Yf44vBUYdM-credit-card-icons.png"></div></div></td> <td><div class="htmlSection" id="tfa_2608"><div class="htmlContent" id="tfa_2608-HTML"><img style="max-width: 100%; width: 125px; float:right;" alt="Your data is protected by SSL" src="//www.tfaforms.com/forms/get_image/216226/GZJIw3wTwkXxSrwscmO5QoSkXQkwayBTlfahVUrqKnyxxppK5OvqOICpJD6KYyDO-security-icon.png"></div></div></td> </tr> <tr> <td><div class="oneField field-container-D labelsAbove " id="tfa_2243-D"> <label id="tfa_2243-L" class="label preField reqMark" for="tfa_2243">Name on Card</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_2243" name="tfa_2243" value="" title="Name on Card" class="required"></div> </div></td> <td><div class="oneField field-container-D labelsAbove " id="tfa_2249-D"> <label id="tfa_2249-L" class="label preField reqMark" for="tfa_2249">Billing Email</label><br><div class="inputWrapper"> <input aria-required="true" type="text" id="tfa_2249" name="tfa_2249" value="" autocomplete="off" aria-describedby="tfa_2249-HH" title="Billing Email" class="validate-email required"><span class="field-hint-inactive" id="tfa_2249-H"><span id="tfa_2249-HH" class="hint">Your receipt will be emailed here.</span></span> </div> </div></td> </tr> </table></div> <div id="tfa_2614" class="section column group"><table class="columnLayout"><tr><td><div id="tfa_2615" class="section inline group"> <div class="oneField field-container-D labelsAbove " id="tfa_2244-D"> <label id="tfa_2244-L" class="label preField reqMark" for="tfa_2244">Card Number</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_2244" name="tfa_2244" value="" autocomplete="off" placeholder="●●●●●●●●●●●●●●●●" title="Card Number" class="validate-custom /^[0-9]*$/ required"></div> </div> <div class="oneField field-container-D labelsAbove " id="tfa_2246-D"> <label id="tfa_2246-L" class="label preField reqMark" for="tfa_2246">MM</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_2246" name="tfa_2246" value="" placeholder="MM" min="1" max="12" title="MM" class="validate-integer required"></div> </div> <div class="oneField field-container-D labelsAbove " id="tfa_2247-D"> <label id="tfa_2247-L" class="label preField reqMark" for="tfa_2247">YY</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_2247" name="tfa_2247" value="" placeholder="YY" min="0" max="9999" title="YY" class="validate-integer required"></div> </div> <div class="oneField field-container-D labelsAbove " id="tfa_2248-D"> <label id="tfa_2248-L" class="label preField reqMark" for="tfa_2248">Code</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_2248" name="tfa_2248" value="" autocomplete="off" placeholder="●●●" title="Code" class="required"></div> </div> </div></td></tr></table></div> </td></tr></tbody></table> </div> <div class="htmlSection" id="tfa_2613"><div class="htmlContent" id="tfa_2613-HTML"><hr style="width:100%; padding:0px;margin:0px; border-top: 2px solid rgba(30,85,123,1);"></div></div> <input type="hidden" id="tfa_2354" name="tfa_2354" value="" class="formula=ALLOCATION calc-CAMPAIGN"><input type="hidden" id="tfa_2620" name="tfa_2620" value="" class="formula=MEMOPT calc-FREQUENCY"><input type="hidden" id="tfa_2578" name="tfa_2578" value="price_HMFG16cZsYcMqA" class=""><input type="hidden" id="STRIPE_CUSTOMER_502637" name="STRIPE_CUSTOMER_502637" value="" class=""><input type="hidden" id="STRIPE_PAYMENT_METHOD_502637" name="STRIPE_PAYMENT_METHOD_502637" value="" class=""><input type="hidden" id="STRIPE_PAYMENT_INTENT_502637" name="STRIPE_PAYMENT_INTENT_502637" value="" class=""><input type="hidden" id="STRIPE_SETUP_INTENT_502637" name="STRIPE_SETUP_INTENT_502637" value="" class=""><input type="hidden" id="STRIPE_SUBSCR_502637" name="STRIPE_SUBSCR_502637" value="" class=""><input type="hidden" id="STRIPE_CHARGE_502637" name="STRIPE_CHARGE_502637" value="" class=""><div class="actions" id="4856707-A" data-contentid="submit_button"> <div id="google-captcha" style="display: none"> <br><div 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id="tfa_dbWorkflowSessionUuid"><input type="hidden" value="1732688374" name="tfa_dbTimeStarted" id="tfa_dbTimeStarted" autocomplete="off"><input type="hidden" value="87" name="tfa_dbVersionId" id="tfa_dbVersionId"><input type="hidden" value="" name="tfa_switchedoff" id="tfa_switchedoff"> </form> </div></div><div class="wFormFooter"><p class="supportInfo"><br></p></div> <p class="supportInfo" > </p> </div> </div> <script src='https://www.tfaforms.com/js/iframe_message_helper_internal.js?v=2'></script> </body> </html>