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<div class="boxes"> <div class="box box1"> <h1>Support Nurses Today!</h1> <div> <p></p>With a gift to the American Nurses Foundation, you are helping to create a healthy world through the power of nursing!</p></div> <div><p></p> Donate below, or <a href="https://www.nursingworld.org/foundation/donate/">click here</a> to find out other ways to make a donation.</div> <div><p></p>If you prefer to speak with a Foundation staff member, please call 1-800-284-2378.</div> <div><p></p>Thank you for your support of nurses and the nursing profession.</div> </div> <div class="box box2"> </br></br></br> <p style="text-align: center;"> <img alt="" class="responsive" src="https://www.nursingworld.org/~49f27a/globalassets/foundation/donation-form/anfdonation-header1.jpg" /> </p> </div> </div> <div class="row"> <div class="col-sm-9 "> <div><label class="control-label" id="fix">Select Amount <span class="requiredflag">*</span></label></div> <a href="" class="donationamount btn btn-secondary" role="button" value="25">$25</a> <a href="" class="donationamount btn btn-secondary" role="button" value="50">$50</a> <a href="" class="donationamount btn btn-secondary" role="button" value="100">$100</a>  <a href="" class="donationamount btn btn-secondary" role="button" value="250">$250</a> <a href="" class="donationamount btn btn-secondary" role="button" value="500">$500</a> <a href="" class="donationamount btn btn-secondary" role="button" value="1000">$1000</a> <a href="" class="donationamount btn btn-secondary" role="button" value="0">Other</a> </div> </div> <div class="row" id="donationamountline" style="display: none;"> <div class="col-sm-12 "> <div class="form-inline"> <label class="control-label">Donation Amount <span class="requiredflag">*</span></label> $ <input type="number" id="donationamount" class="form-control number required" placeholder="Amount" value="0" min="1" step="any" /> <span id="donationamounterror" style="">Minimum online donation amount is $1</span> </div> </div> </div> <div class="row"> <div class="col-sm-12 form-inline"> <div class="radio"> <label class="radio-inline"> <input type="radio" name="repeat" class="repeat" id="repeat1" checked /> One Time Donation </label> </div> <br /> <div class="radio"> <label class="radio-inline"> <input type="radio" name="repeat" class="repeat" id="repeatx" /> Sustaining Donation (Monthly) </label> </div> <div id="repeattimeline"> <input id="repeattime" type="hidden" value="0" /> <span id="totaldonation" style="display: none;"></span> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <label class="control-label">Designation <span class="requiredflag">*</span></label> <select id="impactCASH" class="form-control impact"> <option value="44215" >Where the Need is Greatest</option> <option value="44243" >Florence Nightingale Endowment</option> <option value="44255" >Nursing Research Grant Program</option> <option value="44258" >ANF Margaretta Styles Research Operating</option> <option value="47128973" >Healthy Nurse, Healthy Nation</option> <option value="52076375" >Washington Policy Fellowship</option> <option value="362236559" >Health and Well-Being</option> </select> <select id="impactPLEDGE" class="form-control impact" style="display:none;"> <option value="44214" >Where the Need is Greatest</option> <option value="47128983" >Healthy Nurse, Healthy Nation</option> <option value="47129783" >Florence Nightingale Endowment</option> <option value="47129795" >ANF Margaretta Styles Endowed Research Pledge</option> <option value="48471147" >Nursing Research Grant Program</option> <option value="52076387" >Washington Policy Fellowship</option> <option value="362236465" >Health and Well-Being</option> </select>  </div> </div> </div> </div> <div class="row "> <div class="col-sm-12"> <div class="row "> <div class="col-sm-12"> <div class="checkbox"> <label> <input type="checkbox" id="USR_IS_NURSE_ck" value="x" /> Yes, I am a Registered Nurse (RN) </label> </div> </div> </div> </div> </div> <div class="row "> <div class="col-sm-12"> <div class="row "> <div class="col-sm-12"> <div class="checkbox"> <label> <input type="checkbox" id="on_behalf_company_ck" value="x" /> This donation is on behalf of a company </label> </div> </div> </div> </div> </div> <div class="panel panel-default" id="on_behalf_company" style="display: none;"> <div class="panel-body"> <div class="row"> <div class="col-sm-3"> <label class="control-label">Company Name<span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <span class="fr"> <input type="text" class="form-control required" id="USR_COMPANY_NAME" /> </span> </div> </div> </div> </div> <div class="row "> <div class="col-sm-12"> <div class="row "> <div class="col-sm-12"> <label class="control-label">Tribute – Honor a Nurse</label> <div class="checkbox"> <label> <input type="checkbox" id="dedicationforck" value="x" /> Yes, I would like to dedicate my donation in honor or memory of someone </label> </div> </div> </div> </div> </div> <div class="panel panel-default" id="dedicationfor" style="display: none;"> <div class="panel-body"> <div class="row "> <div class="col-sm-2"> <label class="control-label" style="line-height: 36px;">This Donation is</label> </div> <div class="col-sm-10 form-inline"> <div class="radio"> <label class="radio-inline"> <input type="radio" name="tribute" class="" id="honor" checked /> In honor of </label> <label class="radio-inline"> <input type="radio" name="tribute" class="" id="memory" /> In memory of </label> </div> </div> </div> <div class="row"> <div class="col-sm-2"> <label class="control-label">Name of Tributee<span class="requiredflag">*</span></label> </div> <div class="col-sm-4"> <input type="text" id="tributename" class="form-control required" placeholder="" value="" /> </div> </div> <div class="row"> <div class="col-sm-12"> <label class="control-label">Tribute Message</label> (Maximum characters: 255) <br>If you would like to write more about your tributee, please send the full message to <a href="mailto:givetonursing@ana.org">givetonursing@ana.org</a>. <textarea class="form-control" rows="3" id="tributemessage" maxlength="255"></textarea> </div> </div> <div class="row "> <div class="col-sm-12"> Your tribute message will be shared on givetonursing.org and other listings. </div> </div> <div class="row "> <div class="col-sm-12"> <div class="checkbox"> <label> <input type="checkbox" id="donationtock" value="x" />Please send a note about my tribute to the following contact: </label> </div> </div> </div> <div id="donationto" class="panel1 panel-default" style="display: none;"> <div class="row "> <div class="col-sm-12"> <div class="checkbox"> <label> <input type="checkbox" id="anonymous" value="x" />Please keep my name anonymous in the letter you send. </label> </div> </div> </div> <div class="panel-body"> <div class="row"> <div class="col-sm-8"> <div class="row"> <div class="col-sm-3"> <label class="fl">First Name <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <span class="fr"><input type="text" class="form-control required" value="" id="firstname1" /></span> </div> </div> <div class="row"> <div class="col-sm-3"> <label class="fl">Last Name <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <span class="fr"><input type="text" class="form-control required" value="" id="lastname1" /></span> </div> </div> <div class="row"> <div class="col-sm-3"> <label class="fl">Email <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <span class="fr"> <input type="text" class="form-control required email" id="email1" /> </span> </div> </div> <div id="phone1" class="phone"> </div> <div id="address1" class="address"> </div> </div> </div> </div> </div> </div> </div> <div class=" panel panel-default"> <div class="panel-body"> <div class="row"> <div class="col-sm-12"> <label class="control-label">My Personal Contact Information</label> </div> </div> <div class="row"> <div class="col-sm-8"> <div class="row"> <div class="col-sm-3"> <label class="control-label">Email <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <input type="text" class="form-control email required" id="email2" /> <div id="duplicateemail"> </div> </div> </div> <div id="existingemail"> <div class="row"> <div class="col-sm-3"> <label class="control-label">First Name <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <input type="text" class="form-control required" id="firstname2" /> </div> </div> <div class="row"> <div class="col-sm-3"> <label class="control-label">Last Name <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <input type="text" class="form-control required" id="lastname2" /> </div> </div> <div class="row"> <div class="col-sm-3"> <label class="control-label">Credentials</label> </div> <div class="col-sm-9"> <input type="text" class="form-control" id="credentials2" /> </div> </div> <div id="address2" class="address"> </div> <div id="phone2" class="phone"> </div> </div> </div> </div> </div> </div> <div id="payments"> <ul class="nav nav-tabs"> <li class="active"><a data-toggle="tab" href="#cc" id="cclink">Pay By Credit Card</a></li> <li><a data-toggle="tab" href="#echeck" id="echecklink" style="display: none;">Pay By eCheck</a></li> </ul> <div class="tab-content"> <div id="cc" class="tab-pane fade in active"> <div class="row"> <div class="col-sm-8"> <div class="row"> <div class="col-sm-3"> <label class="control-label">We Honor</label> </div> <div class="col-sm-9"> <img src="/ANFDonation/Content/images/AMEX.png" title="American Express" /> <img src="/ANFDonation/Content/images/DISCOVER.png" title="Discover" /> <img src="/ANFDonation/Content/images/MASTER_CARD.png" title="Master Card" /> <img src="/ANFDonation/Content/images/VISA.png" title="Visa" /> </div> </div> <div class="row"> <div class="col-sm-3"> <label class="control-label">Card Number <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <input id="cardnumber" maxlength="16" class="form-control required cardnumber" /> </div> </div> <div class="row"> <div class="col-sm-3"> <label class="control-label">Name on Card <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <input id="cardname" class="form-control required" maxlength="40" /> </div> </div> <div class="row"> <div class="col-sm-3"> <label class="control-label">Expiration Date <span class="requiredflag">*</span></label> </div> <div class="col-sm-3"> <select id="cardmonth" class="form-control required"> <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" >Jun</option> <option value="7" >July</option> <option value="8" >August</option> <option value="9" >September</option> <option value="10" >October</option> <option value="11" selected>November</option> <option value="12" >December</option> </select> </div> <div class="col-sm-3"> <select id="cardyear" class="form-control required"> <option value="2024">2024</option> <option value="2025">2025</option> <option value="2026">2026</option> <option value="2027">2027</option> <option value="2028">2028</option> <option value="2029">2029</option> <option value="2030">2030</option> <option value="2031">2031</option> <option value="2032">2032</option> <option value="2033">2033</option> <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> <option value="2040">2040</option> <option value="2041">2041</option> <option value="2042">2042</option> <option value="2043">2043</option> </select> </div> <div class="col-sm-3"> </div> </div> <div class="row"> <div class="col-sm-3"> <label class="control-label">Security Code <span class="requiredflag">*</span></label> </div> <div class="col-sm-3"> <input id="cwcode" class="form-control required" maxlength="4" /> </div> <div class="col-sm-3"> <img src="/ANFDonation/Content/Images/cvv.png" height="26" width="43" alt="For Mastercard, Visa or Discover, it is the last three digits in the signature area on the back of the card. For American Express, it is the four digits on the front of the card." /> </div> </div> <div class="row"> <div class="col-sm-3"> </div> </div> <div id="sameasrow" class="row " > <div class="col-sm-12"> <div class="checkbox"> <label> <input type="checkbox" id="sameaddressforcc" value="x" checked /> Use same address as my personal contact information </label> </div> </div> </div> <div id="ccaddress" style='display: none;'> <div class="row"> <div class="col-sm-3"> <label class="fl">Address <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <span class="fr"><input type="text" class="form-control required" value="" id="ADDRESS_13" maxlength="65" /></span> </div> </div> <div class="row"> <div class="col-sm-3"> <label class="fl">City <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <span class="fr"><input type="text" class="form-control required" value="" id="CITY3" maxlength="40"></span> </div> </div> <div class="row"> <div class="col-sm-3"> <label class="fl">State <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <span class="fr"> <select class="form-control required" id="STATE3"> <option value="AL">Alabama</option> <option value="AK">Alaska</option> <option value="AZ">Arizona</option> <option value="AR">Arkansas</option> <option value="AA">Armed Forces Americas</option> <option value="AE">Armed Forces Europe, Middle East</option> <option value="AP">Armed Forces Pacific</option> <option value="CA">California</option> <option value="CZ">Canal Zone</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="GU">Guam</option> <option value="HI">Hawaii</option> <option value="ID">Idaho</option> <option value="IL">Illinois</option> <option value="IN">Indiana</option> <option value="IA">Iowa</option> <option value="KS">Kansas</option> <option value="KY">Kentucky</option> <option value="LA">Louisiana</option> <option value="ME">Maine</option> <option value="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="MP">Northern Mariana Islands</option> <option value="OH">Ohio</option> <option value="OK">Oklahoma</option> <option value="OR">Oregon</option> <option value="PI">Pacific Islands</option> <option value="PA">Pennsylvania</option> <option value="PR">Puerto Rico</option> <option value="RI">Rhode Island</option> <option value="SC">South Carolina</option> <option value="SD">South Dakota</option> <option value="TN">Tennessee</option> <option value="TX">Texas</option> <option value="TT">Trust Territories</option> <option value="UT">Utah</option> <option value="VT">Vermont</option> <option value="VI">Virgin Islands</option> <option value="VA">Virginia</option> <option value="WA">Washington</option> <option value="WV">West Virginia</option> <option value="WI">Wisconsin</option> <option value="WY">Wyoming</option> </select> </span> </div> </div> <div class="row"> <div class="col-sm-3"> <label class="fl">Zip Code <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <span class="fr"><input type="text" class="form-control required" value="" id="POSTAL_CODE3" maxlength="15" /></span> </div> </div> <div class="row"> <div class="col-sm-3"> <label class="fl">Country <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <span class="fr"> <select class="form-control required" id="COUNTRY3"> <option value="AFG" > Afghanistan </option> <option value="ALA" > Åland Islands </option> <option value="ALB" > Albania </option> <option value="DZA" > Algeria </option> <option value="ASM" > American Samoa </option> <option value="AND" > Andorra </option> <option value="AGO" > Angola </option> <option value="AIA" > Anguilla </option> <option value="ATA" > Antarctica </option> <option value="ATG" > Antigua And Barbuda </option> <option value="ARG" > Argentina </option> <option value="ARM" > Armenia </option> <option value="ABW" > Aruba </option> <option value="AUS" > Australia </option> <option value="AUT" > Austria </option> <option value="AZE" > Azerbaijan </option> <option value="BHS" > Bahamas </option> <option value="BHR" > Bahrain </option> <option value="BGD" > Bangladesh </option> <option value="BRB" > Barbados </option> <option value="BLR" > Belarus </option> <option value="BEL" > Belgium </option> <option value="BLZ" > Belize </option> <option value="BEN" > Benin </option> <option value="BMU" > Bermuda </option> <option value="BTN" > Bhutan </option> <option value="BOL" > Bolivia </option> <option value="BES" > Bonaire, Sint Eustatius and Saba </option> <option value="BIH" > Bosnia and Herzegovina </option> <option value="BWA" > Botswana </option> <option value="BVT" > Bouvet Island </option> <option value="BRA" > Brazil </option> <option value="IOT" > British Indian Ocean Territory </option> <option value="BRN" > Brunei Darussalam </option> <option value="BGR" > Bulgaria </option> <option value="BFA" > Burkina Faso </option> <option value="BDI" > Burundi </option> <option value="CPV" > Cabo Verde </option> <option value="KHM" > Cambodia </option> <option value="CMR" > Cameroon </option> <option value="CAN" > Canada </option> <option value="CYM" > Cayman Islands </option> <option value="CAF" > Central African Republic </option> <option value="TCD" > Chad </option> <option value="CHL" > Chile </option> <option value="CHN" > China </option> <option value="CXR" > Christmas Island </option> <option value="CCK" > Cocos (Keeling) Islands </option> <option value="COL" > Colombia </option> <option value="COM" > Comoros </option> <option value="COG" > Congo </option> <option value="COD" > Congo, Democratic Republic of the </option> <option value="COK" > Cook Islands </option> <option value="CRI" > Costa Rica </option> <option value="CIV" > Côte d'Ivoire </option> <option value="HRV" > Croatia (Hrvatska) </option> <option value="CUB" > Cuba </option> <option value="CUW" > Curaçao </option> <option value="CYP" > Cyprus </option> <option value="CZE" > Czech Republic </option> <option value="DNK" > Denmark </option> <option value="DJI" > Djibouti </option> <option value="DMA" > Dominica </option> <option value="DOM" > Dominican Republic </option> <option value="ECU" > Ecuador </option> <option value="EGY" > Egypt </option> <option value="SLV" > El Salvador </option> <option value="GNQ" > Equatorial Guinea </option> <option value="ERI" > Eritrea </option> <option value="EST" > Estonia </option> <option value="ETH" > Ethiopia </option> <option value="EUR" > European Community </option> <option value="FLK" > Falkland Islands </option> <option value="FRO" > Faroe Islands </option> <option value="FJI" > Fiji </option> <option value="FIN" > Finland </option> <option value="FRA" > France </option> <option value="GUF" > French Guiana </option> <option value="PYF" > French Polynesia </option> <option value="ATF" > French Southern Territories </option> <option value="GAB" > Gabon </option> <option value="GMB" > Gambia </option> <option value="GEO" > Georgia </option> <option value="DEU" > Germany </option> <option value="GHA" > Ghana </option> <option value="GIB" > Gibraltar </option> <option value="GRC" > Greece </option> <option value="GRL" > Greenland </option> <option value="GRD" > Grenada </option> <option value="GLP" > Guadeloupe </option> <option value="GUM" > Guam </option> <option value="GTM" > Guatemala </option> <option value="GGY" > Guernsey </option> <option value="GIN" > Guinea </option> <option value="GNB" > Guinea-Bissau </option> <option value="GUY" > Guyana </option> <option value="HTI" > Haiti </option> <option value="HMD" > Heard Island and McDonald Islands </option> <option value="VAT" > Holy See (Vatican City) </option> <option value="HND" > Honduras </option> <option value="HKG" > Hong Kong </option> <option value="HUN" > Hungary </option> <option value="ISL" > Iceland </option> <option value="IND" > India </option> <option value="IDN" > Indonesia </option> <option value="IRN" > Iran, Islamic Republic of </option> <option value="IRQ" > Iraq </option> <option value="IRL" > Ireland </option> <option value="IMN" > Isle of Man </option> <option value="ISR" > Israel </option> <option value="ITA" > Italy </option> <option value="JAM" > Jamaica </option> <option value="JPN" > Japan </option> <option value="JEY" > Jersey </option> <option value="JOR" > Jordan </option> <option value="KAZ" > Kazakhstan </option> <option value="KEN" > Kenya </option> <option value="KIR" > Kiribati </option> <option value="KOR" > Korea, Republic of </option> <option value="PRK" > Korea, Democratic People's Republic of </option> <option value="KWT" > Kuwait </option> <option value="KGZ" > Kyrgyzstan </option> <option value="LAO" > Lao People's Democratic Republic </option> <option value="LVA" > Latvia </option> <option value="LBN" > Lebanon </option> <option value="LSO" > Lesotho </option> <option value="LBR" > Liberia </option> <option value="LBY" > Libya </option> <option value="LIE" > Liechtenstein </option> <option value="LTU" > Lithuania </option> <option value="LUX" > Luxembourg </option> <option value="MAC" > Macau </option> <option value="MKD" > Macedonia, Former Yugoslav Republic of </option> <option value="MDG" > Madagascar </option> <option value="MWI" > Malawi </option> <option value="MYS" > Malaysia </option> <option value="MDV" > Maldives </option> <option value="MLI" > Mali </option> <option value="MLT" > Malta </option> <option value="MHL" > Marshall Islands </option> <option value="MTQ" > Martinique </option> <option value="MRT" > Mauritania </option> <option value="MUS" > Mauritius </option> <option value="MYT" > Mayotte </option> <option value="MEX" > Mexico </option> <option value="FSM" > Micronesia, Federated States of </option> <option value="MDA" > Moldova, Republic of </option> <option value="MCO" > Monaco </option> <option value="MNG" > Mongolia </option> <option value="MNE" > Montenegro </option> <option value="MSR" > Montserrat </option> <option value="MAR" > Morocco </option> <option value="MOZ" > Mozambique </option> <option value="MMR" > Myanmar </option> <option value="NAM" > Namibia </option> <option value="NRU" > Nauru </option> <option value="NPL" > Nepal </option> <option value="NLD" > Netherlands </option> <option value="NCL" > New Caledonia </option> <option value="NZL" > New Zealand </option> <option value="NIC" > Nicaragua </option> <option value="NER" > Niger </option> <option value="NGA" > Nigeria </option> <option value="NIU" > Niue </option> <option value="NFK" > Norfolk Island </option> <option value="MNP" > Northern Mariana Islands </option> <option value="NOR" > Norway </option> <option value="OMN" > Oman </option> <option value="PAK" > Pakistan </option> <option value="PLW" > Palau </option> <option value="PSE" > Palestine, State of </option> <option value="PAN" > Panama </option> <option value="PNG" > Papua New Guinea </option> <option value="PRY" > Paraguay </option> <option value="PER" > Peru </option> <option value="PHI" > Philippines </option> <option value="PCN" > Pitcairn </option> <option value="POL" > Poland </option> <option value="PRT" > Portugal </option> <option value="PRI" > Puerto Rico </option> <option value="QAT" > Qatar </option> <option value="REU" > Réunion </option> <option value="ROM" > Romania </option> <option value="RUS" > Russian Federation </option> <option value="RWA" > Rwanda </option> <option value="BLM" > Saint Barthélemy </option> <option value="KNA" > Saint Kitts And Nevis </option> <option value="LCA" > Saint Lucia </option> <option value="MAF" > Saint Martin (French part) </option> <option value="WSM" > Samoa </option> <option value="SMR" > San Marino </option> <option value="STP" > Sao Tome And Principe </option> <option value="SAU" > Saudi Arabia </option> <option value="SEN" > Senegal </option> <option value="SRB" > Serbia </option> <option value="SYC" > Seychelles </option> <option value="SLE" > Sierra Leone </option> <option value="SGP" > Singapore </option> <option value="SXM" > Sint Maarten (Dutch part) </option> <option value="SVK" > Slovakia </option> <option value="SVN" > Slovenia </option> <option value="SLB" > Solomon Islands </option> <option value="SOM" > Somalia </option> <option value="ZAF" > South Africa </option> <option value="SGS" > South Georgia </option> <option value="SSD" > South Sudan </option> <option value="ESP" > Spain </option> <option value="LKA" > Sri Lanka </option> <option value="VCT" > St Vincent And Grenadines </option> <option value="SHN" > St. Helena </option> <option value="SPM" > St. Pierre And Miquelon </option> <option value="SDN" > Sudan </option> <option value="SUR" > Suriname </option> <option value="SJM" > Svalbard and Jan Mayen </option> <option value="SWZ" > Swaziland </option> <option value="SWE" > Sweden </option> <option value="CHE" > Switzerland </option> <option value="SYR" > Syrian Arab Republic </option> <option value="TWN" > Taiwan </option> <option value="TJK" > Tajikistan </option> <option value="TZA" > Tanzania, United Republic of </option> <option value="THA" > Thailand </option> <option value="TLS" > Timor-Leste </option> <option value="TGO" > Togo </option> <option value="TKL" > Tokelau </option> <option value="TON" > Tonga </option> <option value="TTO" > Trinidad And Tobago </option> <option value="TUN" > Tunisia </option> <option value="TUR" > Turkey </option> <option value="TKM" > Turkmenistan </option> <option value="TCA" > Turks And Caicos Islands </option> <option value="TUV" > Tuvalu </option> <option value="UGA" > Uganda </option> <option value="UKR" > Ukraine </option> <option value="AE" > United Arab Emirates </option> <option value="UAE" > United Arab Emirates </option> <option value="GBR" > United Kingdom </option> <option value="USA" selected > United States </option> <option value="UMI" > United States Minor Outlying Islands </option> <option value="URY" > Uruguay </option> <option value="UZB" > Uzbekistan </option> <option value="VUT" > Vanuatu </option> <option value="VEN" > Venezuela </option> <option value="VNM" > Viet Nam </option> <option value="VGB" > Virgin Islands (British) </option> <option value="VIR" > Virgin Islands (U.S.) </option> <option value="WLF" > Wallis And Futuna Islands </option> <option value="ESH" > Western Sahara </option> <option value="YEM" > Yemen </option> <option value="ZMB" > Zambia </option> <option value="ZWE" > Zimbabwe </option> </select> </span> </div> </div> </div> </div> </div> </div> <div id="ETF" class="tab-pane fade"> <div class="row"> <div class="col-sm-8"> <div class="row"> <div class="col-sm-3"> <label class="control-label">Routing Number <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <input id="etfroutingnumber" class="form-control required" /> </div> </div> <div class="row"> <div class="col-sm-3"> <label class="control-label">Bank Name <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <input id="etfinstitution" class="form-control required" /> </div> </div> <div class="row"> <div class="col-sm-3"> <label class="control-label">Account Number <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <input id="etfaccountnumber" class="form-control required" /> </div> </div> <div class="row"> <div class="col-sm-3"> <label class="control-label">Account Type <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <select id="etfaccounttype" class="form-control required"> <option value="CHECKING">Checking</option> <option value="SAVING">Saving</option> </select> </div> </div> </div> </div> </div> <div id="echeck" class="tab-pane fade"> <div class="row"> <div class="col-sm-8"> <div class="row"> <div class="col-sm-4"> <label class="control-label">Bank Routing Number <span class="requiredflag">*</span></label> </div> <div class="col-sm-8"> <input id="echeckroutingnumber" class="form-control required" /> </div> </div> <div class="row"> <div class="col-sm-4"> <label class="control-label">Bank Account Number <span class="requiredflag">*</span></label> </div> <div class="col-sm-8"> <input id="echeckaccountnumber" class="form-control required" /> </div> </div> <div class="row"> <div class="col-sm-4"> <label class="control-label">Check Number <span class="requiredflag">*</span></label> </div> <div class="col-sm-8"> <input id="echecknumber" class="form-control required" /> </div> </div> <div class="row"> <div class="col-sm-4"> <label class="control-label">Account Holder Full Name <span class="requiredflag">*</span></label> </div> <div class="col-sm-8"> <input id="echeckname" class="form-control required" /> </div> </div> <div class="row"> <div class="col-sm-4"> <label class="control-label">Personal ID Type <span class="requiredflag">*</span></label> </div> <div class="col-sm-8"> <select id="echeckIDType" class="form-control required"> <option value="DL">Drivers License</option> <option value="SSN">Social Security Number</option> </select> </div> </div> <div class="row ssnrow" style="display:none"> <div class="col-sm-4"> <label class="control-label">Social Security Number <span class="requiredflag">*</span></label> </div> <div class="col-sm-8"> <input id="ssnNumber" class="form-control required" /> </div> </div> <div class="row ssnrow" style="display:none"> <div class="col-sm-4"> <label class="control-label">Date Of Birth <span class="requiredflag">*</span></label> </div> <div class="col-sm-8"> <div class="input-group date form_date col-md-5" data-date="" data-date-format="mm/dd/yyyy"> <input class="form-control" size="16" type="text" value="" id="dateOfBirth"> <span class="input-group-addon"><span class="glyphicon glyphicon-calendar"></span></span> </div> </div> </div> <div class="row driverrow"> <div class="col-sm-4"> <label class="control-label">Driver License/ID Number <span class="requiredflag">*</span></label> </div> <div class="col-sm-8"> <input id="echeckidNumber" class="form-control required" /> </div> </div> <div class="row driverrow"> <div class="col-sm-4"> <label class="control-label">Driver License/ID State <span class="requiredflag">*</span></label> </div> <div class="col-sm-8"> <select id="echeckstate" class="form-control required"> <option value="AL">Alabama</option> <option value="AK">Alaska</option> <option value="AZ">Arizona</option> <option value="AR">Arkansas</option> <option value="AA">Armed Forces Americas</option> <option value="AE">Armed Forces Europe, Middle East</option> <option value="AP">Armed Forces Pacific</option> <option value="CA">California</option> <option value="CZ">Canal Zone</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="GU">Guam</option> <option value="HI">Hawaii</option> <option value="ID">Idaho</option> <option value="IL">Illinois</option> <option value="IN">Indiana</option> <option value="IA">Iowa</option> <option value="KS">Kansas</option> <option value="KY">Kentucky</option> <option value="LA">Louisiana</option> <option value="ME">Maine</option> <option value="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="MP">Northern Mariana Islands</option> <option value="OH">Ohio</option> <option value="OK">Oklahoma</option> <option value="OR">Oregon</option> <option value="OT">Outside of the US</option> <option value="PI">Pacific Islands</option> <option value="PA">Pennsylvania</option> <option value="PR">Puerto Rico</option> <option value="RI">Rhode Island</option> <option value="SC">South Carolina</option> <option value="SD">South Dakota</option> <option value="TN">Tennessee</option> <option value="TX">Texas</option> <option value="TT">Trust Territories</option> <option value="UT">Utah</option> <option value="VT">Vermont</option> <option value="VI">Virgin Islands</option> <option value="VA">Virginia</option> <option value="WA">Washington</option> <option value="WV">West Virginia</option> <option value="WI">Wisconsin</option> <option value="WY">Wyoming</option> </select> </div> </div> <div class="row"> <div class="col-sm-2"> <img src="/ANFDonation/Content/Images/telecheck.png" alt="TeleCheck" /> </div> <div class="col-sm-10"> <p> For returned checks, there will be a fee charged with the amount listed in the <a href="http://www.firstdata.com/en_us/customer-center/merchants/support/telecheck-returned-check-fees.html" target="_blank">Returned Check Fees</a> Table. </p> <p> Please click on <a href="http://www.telecheck.com/ica/privacy_policy.html" target="_blank">TeleCheck Privacy Policy</a> for privacy policy details. </p> <p> For questions, please check the <a href="http://www.telecheck.com/ica/internetcheckfaq.html" target="_blank">TeleCheck Internet Check Acceptance FAQ</a> and <a href="http://www.telecheck.com/ica/internetevalfaq.html" target="_blank">TeleCheck Evaluation Process FAQ</a> . You may also contact us at [MerchantPhoneNumber] during business hours for more questions. </p> <p> I authorize an electronic debit in the amount of $<span id="lblPrice">250.00</span> USD. This withdrawal will be processed using the regular banking system. </p> </div> </div> <div class="row"> <div class="col-sm-12"> <div class="checkbox"> <label> <input type="checkbox" id="authorize" value="yes" class=" required" /> <strong>I authorize this transaction</strong> </label> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row" id="paymentbuttonrow"> <div class="col-sm-12 text-center"> <button type="button" class="btn btn-primary process1">Process Payment</button> </div> </div> <div id="myModalMonthlyCC" class="modal" role="dialog"> <div class="modal-dialog">  <div class="modal-content"> <div class="modal-header"> <button type="button" class="close" data-dismiss="modal">×</button> <h4 class="modal-title">Terms and Conditions of Monthly Contribution</h4> </div> <div class="modal-body"> <p> I am authorizing American Nurses Foundation to charge my monthly contribution to my credit or debit card on or after the first of each month. I understand that I may cancel this authorization by providing American Nurses Foundation written notice twenty (20) days prior to deduction. </p> <p> I authorize monthly recurring electronic payments to the American Nurses Foundation according to these terms and conditions. </p> </div> <div class="modal-footer"> <button type="button" class="btn btn-default pull-left" data-dismiss="modal">Cancel</button> <button type="button" class="btn btn-primary process2" data-dismiss="modal">Process Payment</button> </div> </div> </div> </div> <div id="myModalMonthlyEFT" class="modal" role="dialog"> <div class="modal-dialog">  <div class="modal-content"> <div class="modal-header"> <button type="button" class="close" data-dismiss="modal">×</button> <h4 class="modal-title">Terms and Conditions of Monthly Contribution</h4> </div> <div class="modal-body"> <p> I hereby authorize the American Nurses Foundation to charge my monthly contribution to my bank account on or after the last day of each month until the expiration of the term. I understand that I may cancel this authorization by providing the American Nurses Foundation written notice at least twenty (20) days prior to the date of deduction. </p> <p> I authorize monthly recurring electronic payments to the American Nurses Foundation according to these terms and conditions. </p> </div> <div class="modal-footer"> <button type="button" class="btn btn-default pull-left" data-dismiss="modal">Cancel</button> <button type="button" class="btn btn-primary process2" data-dismiss="modal">Process Payment</button> </div> </div> </div> </div> <div id="myModalPledgeCC" class="modal" role="dialog"> <div class="modal-dialog">  <div class="modal-content"> <div class="modal-header"> <button type="button" class="close" data-dismiss="modal">×</button> <h4 class="modal-title">Terms and Conditions of Monthly Payment</h4> </div> <div class="modal-body"> <p> I am authorizing the American Nurses Foundation to charge my monthly contribution to my credit or debit card on or after the first of each month until the expiration of the term. I understand and agree that this pledge shall be irrevocable until the expiration of the term. </p> <p> I authorize monthly recurring electronic payments to the American Nurses Foundation according to these terms and conditions. </p> </div> <div class="modal-footer"> <button type="button" class="btn btn-default pull-left" data-dismiss="modal">Cancel</button> <button type="button" class="btn btn-primary process2" data-dismiss="modal">Process Payment</button> </div> </div> </div> </div> <div id="myModalPledgeEFT" class="modal" role="dialog"> <div class="modal-dialog">  <div class="modal-content"> <div class="modal-header"> <button type="button" class="close" data-dismiss="modal">×</button> <h4 class="modal-title">Terms and Conditions of Monthly Payment</h4> </div> <div class="modal-body"> <p> I hereby authorize the American Nurses Foundation to charge my monthly contribution to my bank account on or after the last day of each month until the expiration of the term. I understand and agree that this pledge shall be irrevocable until the expiration of the term. </p> <p> I authorize monthly recurring electronic payments to the American Nurses Foundation according to these terms and conditions. </p> </div> <div class="modal-footer"> <button type="button" class="btn btn-default pull-left" data-dismiss="modal">Cancel</button> <button type="button" class="btn btn-primary process2" data-dismiss="modal">Process Payment</button> </div> </div> </div> </div> </form> <script id="address-template-grid" type="text/x-handlebars-template"> <div class="row"> <div class="col-sm-3"> <label class="fl">{{COUNTRYCAPTION}} <span class="requiredflag">*</span></label> </div> <div class="col-sm-9"> <span class="fr"> <select class="form-control {{COUNTRYREQUIRED}}" id="COUNTRY{{prefix}}"> {{#each COUNTRYOPTIONS}} <option value="{{VALUE}}" {{selected}}>{{TEXT}}</option> {{/each}} </select> </span> </div> </div> <div class="row"> <div class="col-sm-3"> <label class="fl">{{ADDRESS1CAPTION}} {{#if ADDRESS1REQUIRED}}<span class="requiredflag">*</span>{{/if}}</label> </div> <div class="col-sm-9"> <span class="fr"><input type="text" class="form-control {{ADDRESS1REQUIRED}}" value="" id="ADDRESS_1{{prefix}}" maxlength="{{ADDRESS1MAXLENGTH}}" /></span> </div> </div> <div class="row"> <div class="col-sm-3"> <label class="fl">{{ADDRESS2CAPTION}} {{#if ADDRESS2REQUIRED}}<span class="requiredflag">*</span>{{/if}}</label> </div> <div class="col-sm-9"> <span class="fr"><input type="text" class="form-control {{ADDRESS2REQUIRED}}" value="" id="ADDRESS_2{{prefix}}" maxlength="{{ADDRESS2MAXLENGTH}}" /></span> </div> </div> {{#if CITYCAPTION}} <div class="row"> <div class="col-sm-3"> <label class="fl">{{CITYCAPTION}} {{#if CITYREQUIRED}}<span class="requiredflag">*</span>{{/if}}</label> </div> <div class="col-sm-9"> <span class="fr"><input type="text" class="form-control {{CITYREQUIRED}}" value="" id="CITY{{prefix}}" maxlength="{{CITYMAXLENGTH}}"></span> </div> </div> {{/if}} {{#if STATECAPTION}} <div class="row"> <div class="col-sm-3"> <label class="fl">{{STATECAPTION}} {{#if STATEREQUIRED}}<span class="requiredflag">*</span>{{/if}}</label> </div> <div class="col-sm-9"> <span class="fr"> {{#if STATEOPTIONS}} <select class="form-control {{STATEREQUIRED}}" id="STATE{{prefix}}"> {{#each STATEOPTIONS}} <option value="{{VALUE}}" {{selected}}>{{TEXT}}</option> {{/each}} </select> {{else}} <input type="text" class="form-control" value="" id="STATE{{prefix}}" maxlength="{{STATEMAXLENGTH}}" /> {{/if}} </span> </div> </div> {{/if}} {{#if POSTALCODECAPTION}} <div class="row"> <div class="col-sm-3"> <label class="fl">{{POSTALCODECAPTION}} {{#if POSTALCODEREQUIRED}} <span class="requiredflag">*</span>{{/if}}</label> </div> <div class="col-sm-9"> <span class="fr"><input type="text" class="form-control {{POSTALCODEREQUIRED}}" value="" id="POSTAL_CODE{{prefix}}" maxlength="{{POSTALCODEMAXLENGTH}}" /></span> </div> </div> {{/if}} </script> <script id="phone-template-grid" type="text/x-handlebars-template"> <div class="row"> <div class="col-sm-3"> <label class="fl">Telephone</label> </div> <div class="col-sm-9"> <select class="form-control" id="PHONECOUNTRY{{prefix}}"> {{#each COUNTRYOPTIONS}} <option value="{{VALUE}}" property={{PROPERTY}} {{selected}}>{{TEXT}}</option> {{/each}} </select> </div> </div> <div class="row"> <div class="col-sm-3"> </div> <div class="col-sm-3"> <input type="text" class="form-control PHONE_AREA_CODE" value="" id="PHONE_AREA_CODE{{prefix}}" maxlength="{{PHONE_AREA_CODE_MAXLENGTH}}" /> </div> <div class="col-sm-1" style="width: 1px;"> - </div> <div class="col-sm-5"> <input type="text" class="form-control" value="" id="PHONE_NUMBER{{prefix}}" maxlength="{{PHONE_NUMBER_MAXLENGTH}}" /> </div> </div> </script> <script type="text/javascript"> jQuery.fn.ForceNumericOnly = function () { return this.each(function () { $(this).keydown(function (e) { var key = e.charCode || e.keyCode || 0; // allow backspace, tab, delete, enter, arrows, numbers and keypad numbers ONLY // home, end, period, and numpad decimal return ( key == 8 || key == 9 || key == 13 || key == 46 || key == 110 || key == 190 || (key >= 35 && key <= 40) || (key >= 48 && key <= 57) || (key >= 96 && key <= 105)); }); }); }; jQuery.fn.ForceAnythingNotNumeric = function () { return this.each(function () { $(this).keydown(function (e) { var key = e.charCode || e.keyCode || 0; // allow backspace, tab, delete, enter, arrows, numbers and keypad numbers ONLY // home, end, period, and numpad decimal return !( //key == 8 || //key == 9 || //key == 13 || //key == 46 || //key == 110 || //key == 190 || //(key >= 35 && key <= 40) || (key >= 48 && key <= 57) || (key >= 96 && key <= 105)); }); }); }; jQuery.fn.ForceUSAZip = function (zipid, countryid) { var country = $(countryid).val(); console.log("ForceUSAZip", country); if (country == null) country = "USA"; if (!(country.length > 0)) country = "USA"; if (country != "USA") { $(zipid).unmask(); return true; } console.log("ForceUSAZip maxlength", country); $(zipid).attr('maxlength', 10); $(zipid).mask('00000-0000'); return this.each(function () { $(this).keydown(function (e) { var key = e.charCode || e.keyCode || 0; //console.log(key); // allow backspace, tab, delete, enter, arrows, numbers and keypad numbers ONLY // home, end, period, and numpad decimal return ( key == 8 || key == 9 || key == 13 || key == 46 || //key == 110 || // "." //key == 190 || key == 109 || key == 173 || //"-" (key >= 35 && key <= 40) || (key >= 48 && key <= 57) || (key >= 96 && key <= 105)); }); }); }; function GetCardType(n) { console.log("GetCardType", n); // visa var re = new RegExp("^4"); if (n.match(re) != null) return "VI"; // Mastercard re = new RegExp("^5[1-5]"); if (n.match(re) != null) return "MC"; // AMEX re = new RegExp("^3[47]"); if (n.match(re) != null) return "AX"; // Discover re = new RegExp("^(6011|622(12[6-9]|1[3-9][0-9]|[2-8][0-9]{2}|9[0-1][0-9]|92[0-5]|64[4-9])|65)"); if (n.match(re) != null) return "DI"; return ""; } </script> <script> function requestRecaptchaToken() { grecaptcha.ready(function () { grecaptcha.execute('6Lcym3ApAAAAAMkrc2xub5nFKgB95hhdKSOvH0-g', { action: 'ANA_Donate' }).then(function (token) { // Add your logic to submit to your backend server here. document.getElementById("GoogleCaptchaToken").value = token; }); }); } function refreshRecaptchaToken() { // Call requestRecaptchaToken to get a new token requestRecaptchaToken(); // Schedule the next token refresh before the current token expires setTimeout(refreshRecaptchaToken, 1000 * 60 * 2); // Refresh every 2 minutes } $(document).ready(function () { console.log("ready"); // Initial token request requestRecaptchaToken(); // Start refreshing the token periodically refreshRecaptchaToken(); $('#donationamount').ForceNumericOnly(); $("#tributemessage").autogrow(); if ('' == 'true') { function jshelp(n) { $('#prefix2').val('MR'); $('#firstname2').val('F' + n); $('#middlename2').val('M' + n); $('#lastname2').val('L' + n); $('#credentials2').val('D' + n); $('#company2').val('C' + n); $('#email2').val('E' + n + 'user@test.com'); $('#PHONECOUNTRY2').val("USA"); $('#PHONE_AREA_CODE2').val('703'); $('#PHONE_NUMBER2').val(n); $('#COUNTRY2').val("USA"); $('#ADDRESS_12').val("18515 Georgia Ave"); $('#ADDRESS_22').val("Suite 400"); $('#ADDRESS_32').val(''); $('#ADDRESS_42').val(''); $('#CITY2').val('Silver Spring'); $('#STATE2').val('MD'); $('#POSTAL_CODE2').val('20190'); //$('#cardtype').val('VI'); $('#cardnumber').val('4111111111111111'); $('#cardname').val('FL' + n); $('#cardmonth').val(2); $('#cardyear').val(2017); $('#cwcode').val('123'); $('#COUNTRY2').val("USA"); $('#ADDRESS_13').val("18515 Georgia Ave"); $('#CITY3').val('Silver Spring'); $('#STATE3').val('MD'); $('#POSTAL_CODE3').val('20190'); $('#etfroutingnumber').val("011500120"); $('#etfinstitution').val('Citizens Bank'); $('#etfaccountnumber').val("19056206"); $('#etfaccounttype').val('CHECKING'); $('#echeckroutingnumber').val("011500120"); $('#echeckaccountnumber').val("19056206"); $('#echecknumber').val("3" + n); $('#echeckname').val("4" + n); $('#echeckIDType').val('DL'); $('#echeckidNumber').val("7" + n); $('#echeckstate').val('VA'); $('#ssnNumber').val("77-77-7777"); $('#dateOfBirth').val('01/01/1980'); $('#prefix1').val("MS"); $('#firstname1').val("A" + n); $('#middlename1').val("B" + n); $('#lastname1').val("C" + n); $('#email1').val("EE" + n + 'user@test.com'); $('#company1').val("C" + n); $('#PHONECOUNTRY1').val("USA"); $('#PHONE_AREA_CODE1').val('703'); $('#PHONE_NUMBER1').val("9" + n); $('#COUNTRY1').val("USA"); $('#ADDRESS_11').val("18515 Georgia Ave"); $('#ADDRESS_21').val("Suite 400"); $('#ADDRESS_31').val(''); $('#ADDRESS_41').val(''); $('#CITY1').val('Silver Spring'); $('#STATE1').val('MD'); $('#POSTAL_CODE1').val('20190'); $('#anonymous').trigger('click'); $('#dedicationforck').trigger('click'); $('#on_behalf_company_ck').trigger('click'); $('#donationtock').trigger('click'); $('#tributename').val("T" + n); $('#tributemessage').val("very long message very long message very long message very long message very long message very long message very long message very long message very long message very long message very long message very long message very long message very long message very long message very long message very long message very long message very long message very long message ") } $('body').on('click', '#test', function () { var n = Math.floor((Math.random() * 100000) + 1); jshelp(n); return false; }); $('body').on('click', '#fix', function () { jshelp(100); return false; }); } $('#cardname').val(''); $('#ADDRESS_13').val(''); $('#CITY3').val(''); $('#STATE3').val(''); $('#POSTAL_CODE3').val(''); $('#PHONECOUNTRY3').val(''); $('body').on('change', '#donationamount', function () { var c = $(this).val(); console.log("lblPrice", lblPrice); $('#lblPrice').html(c); TotalDonation(); }); $('body').on('change', '#firstname2, #middlename2, #lastname2', function () { console.log("cardname"); var middlename2 = $('#middlename2').val(); var cardname = $('#firstname2').val() + ((middlename2.length > 0) ? ' ' + middlename2 : '') + ' ' + $('#lastname2').val(); $('#cardname').val(cardname); }); function FillAddress() { if ($('#sameaddressforcc:checked').length > 0) { if ($('#ADDRESS_12:visible').length > 0 && $('#ADDRESS_12').val().length > 0) { $('#ADDRESS_13').val($('#ADDRESS_12').val()); $('#CITY3').val($('#CITY2').val()); $('#STATE3').val($('#STATE2').val()); $('#POSTAL_CODE3').val($('#POSTAL_CODE2').val()); $('#PHONECOUNTRY3').val($('#PHONECOUNTRY2').val()); $('#ccaddress').hide(); } } else { //$('#ADDRESS_13').val(''); //$('#CITY3').val(''); //$('#STATE3').val(''); //$('#POSTAL_CODE3').val(''); //$('#PHONECOUNTRY3').val("USA"); $('#ccaddress').show(); } } $('body').on('change', '#sameaddressforcc', function () { console.log('sameaddressforcc'); FillAddress(); }); $('body').on('change', '#COUNTRY1', function () { var c = $(this).val(); console.log("c", c); if (c.length > 0) { BuildAddress(1, c, false); $('#PHONECOUNTRY1').val(c); } }); $('body').on('change', '#COUNTRY2', function () { var c = $(this).val(); console.log("c", c); if (c.length > 0) { BuildAddress(2, c, false); $('#PHONECOUNTRY2').val(c); } }); $('body').on('change', '#COUNTRY3', function () { $('#POSTAL_CODE3').ForceUSAZip('#POSTAL_CODE3', "#COUNTRY3"); }); $('#CITY3').ForceAnythingNotNumeric(); $('#POSTAL_CODE3').ForceUSAZip('#POSTAL_CODE3', "#COUNTRY3"); $('#cwcode').ForceNumericOnly(); $('body').on('change', '#PHONECOUNTRY1', function () { var c = $(this).val(); console.log("c", c); if (c.length > 0) { BuildPhone(1, $(this).val(), false); } }); $('body').on('change', '#PHONECOUNTRY2', function () { var c = $(this).val(); console.log("c", c); if (c.length > 0) { BuildPhone(2, $(this).val(), false); } }); BuildAddress(1, "USA", false); BuildAddress(2, "USA", true); $('#firstname2').val(''); $('#middlename2').val(''); $('#lastname2').val(''); $('#credentials2').val(''); $('#company2').val(''); function BuildAddress(prefix, country, populate) { $.ajax({ url: '/ANFDonation/GetAddressStructures', contentType: "application/json; charset=utf-8", dataType: "json", data: { country: country }, success: function (response) { console.log('Success', response, response.length); if (response != null) { response.prefix = prefix; //var saved = []; //jQuery('#address' + prefix).find("input, select").each( function() { // saved.push ([this.id, $(this).val()]); //}); //console.log("saved", saved); var addresstemplatesource1 = jQuery('#address-template-grid').html(); var addresstemplate1 = Handlebars.compile(addresstemplatesource1); address1 = addresstemplate1(response); //console.log("address1", address1); jQuery('#address' + prefix).html(address1); //if (saved != null && saved.length > 0) { // for(var i = 0; i<saved.length;i++) { // jQuery('#' + saved[i][0]).val(saved[i][1]); // } //} if (populate == true) { $('#ADDRESS_12').val(''); $('#ADDRESS_22').val(''); $('#ADDRESS_32').val(''); $('#ADDRESS_42').val(''); $('#CITY2').val(''); $('#STATE2').val(''); $('#statetext').val(''); $('#POSTAL_CODE2').val(''); $('#PHONECOUNTRY2').val(''); $('#email2').val(''); } if (prefix == 1) { console.log("address1 trick"); //address 1 not required by default $('#address1 input').each(function () { if ($(this).hasClass('required')) { $(this).addClass('requiredNo').removeClass('required'); } }); $('#address1 span.requiredflag').hide(); $('#address1 input').on('change', function () { var anyvalue = false; $('#address1 input').each(function () { if ($(this).val().length > 0) { anyvalue = true; return false; } }); console.log("anyvalue", anyvalue); if (anyvalue == true) { $('#address1 input').each(function () { if ($(this).hasClass('requiredNo')) { $(this).addClass('required').removeClass('requiredNo'); } }); $('#address1 span.requiredflag').show(); } else { $('#address1 input').each(function () { if ($(this).hasClass('required')) { $(this).addClass('requiredNo').removeClass('required').removeClass('error'); } }); $('#address1 span.requiredflag').hide(); } }); } $('#CITY' + prefix).ForceAnythingNotNumeric(); $('#POSTAL_CODE' + prefix).ForceUSAZip('#POSTAL_CODE' + prefix, "#COUNTRY" + prefix); } }, error: function () { nalert('Error (2)'); } }); } BuildPhone(1, "USA", false); BuildPhone(2, "USA", true); function BuildPhone(prefix, country, populate) { $.ajax({ url: '/ANFDonation/GetCustomerPhoneStructures', contentType: "application/json; charset=utf-8", dataType: "json", data: { country: country }, success: function (response) { console.log('Success', response, response.length); if (response != null) { response.prefix = prefix; var phonetemplatesource1 = jQuery('#phone-template-grid').html(); var phonetemplate1 = Handlebars.compile(phonetemplatesource1); phone1 = phonetemplate1(response); //console.log("address1", address1); jQuery('#phone' + prefix).html(phone1); if (populate == true) { $('#PHONE_AREA_CODE2').val(''); $('#PHONE_NUMBER2').val(''); } $('#PHONE_AREA_CODE1, #PHONE_NUMBER1, #PHONE_AREA_CODE2, #PHONE_NUMBER2').ForceNumericOnly(); } }, error: function () { nalert('Error (4)'); } }); } $('body').on('click', '.selectpayment', function () { var v = $('input.selectpayment:checked').val(); $('.paymentoption').hide(); $('#' + v).show(); }); $('body').on('click', '.donationamount', function () { $('.donationamount').removeClass('active'); $(this).addClass('active'); var value = $(this).attr('value'); if (value > 0) { $('#donationamount').val(value); $('#donationamountline').hide(); $('#lblPrice').html(value); } else { $('#donationamountline').show(); $('#donationamount').val(''); } TotalDonation(); return false; }); function setImpact() { console.log("setImpact"); if ($('#repeatx:checked').length > 0 && $('#repeattime').val() > 0) { //if ($('#repeattime').val() > 0) { console.log("setImpact 1"); $('#impactCASH').hide(); $('#impactPLEDGE').show(); } else { console.log("setImpact 2"); $('#impactCASH').show(); $('#impactPLEDGE').hide(); } } $('body').on('keyup', '.required', function () { if (!$(this).val()) { $(this).addClass('error'); } else { $(this).removeClass('error'); } }); var startDate = new Date('1915-01-01'), endDate = new Date(); $(".form_date").datetimepicker({ format: 'mm/dd/yyyy', weekStart: 1, todayBtn: false, autoclose: 1, todayHighlight: 1, startView: 4, keyboardNavigation: 1, minView: 2, forceParse: 0, initialDate: new Date(new Date().getFullYear()-18, 1, 1), startDate: startDate, //set start date endDate: endDate //set end date }); $('.form_date input').mask('00/00/0000'); $('#ssnNumber').mask('000-00-0000'); $('body').on('keyup', '#cardnumber', function () { console.log("cardnumber"); var cardnumber = $('#cardnumber').val(); var cardtype = GetCardType(cardnumber); if (cardtype.length > 0) { $(this).removeClass('AX VI MC DI'); $(this).addClass(cardtype); console.log("cardnumber 21", cardtype); } else { $(this).removeClass('AX VI MC DI'); } console.log("cardnumber 2"); if (!(cardtype.length > 0) || !(luhnCheck(cardnumber))) { $(this).addClass('error'); } else { $(this).removeClass('error'); } }); $('body').on('change', '#cardmonth, #cardyear', function () { var cardmonth = $('#cardmonth').val(); var cardyear = $('#cardyear').val(); console.log("cardmonth", cardmonth, cardyear); if ((cardyear == new Date().getFullYear()) && (cardmonth < new Date().getMonth() + 1)) { $('#cardmonth, #cardyear').addClass('error'); } else { $('#cardmonth, #cardyear').removeClass('error'); } }); $('body').on('change', '#dateOfBirth', function () { console.log("dateOfBirth"); var dateOfBirth = $('#dateOfBirth').val(); if (!isValidDate(dateOfBirth)) { $('#dateOfBirth').addClass('error'); } else { $('#dateOfBirth').removeClass('error'); } }); $('body').on('change', '#echeckIDType', function () { console.log("echeckIDType"); var echeckIDType = $('#echeckIDType').val(); if (echeckIDType == 'SSN') { $('.driverrow').hide(); $('.ssnrow').show(); } else { $('.ssnrow').hide(); $('.driverrow').show(); } }); $('body').on('keyup', '#email1', function () { if (!isEmail($(this).val())) { $(this).addClass('error'); } else { $(this).removeClass('error'); } }); var timer; $('body').on('keyup', '#email2', function () { console.log(1); if (!isEmail($(this).val())) { console.log(2); $(this).addClass('error'); } else { console.log(3); $(this).removeClass('error'); } clearTimeout(timer); //clear any running timeout on key up timer = setTimeout(function () { //then give it a second to see if the user is finished //do .post ajax request //then do the ajax call console.log(4); if (!$('#email2').hasClass('error') && $('#email2').val().length > 0 && isEmail($('#email2').val())) { console.log(5); $.ajax({ url: '/ANFDonation/CheckEmail', contentType: "application/json; charset=utf-8", type: 'POST', dataType: "json", data: JSON.stringify({ 'Email': $('#email2').val() }), success: function (response) { console.log('Success', response); $('#duplicateemail').html(''); $('#existingemail, #sameasrow').show(); $('#payments').show(); $('#paymentbuttonrow').show(); $('#ccaddress').hide(); $('#sameaddressforcc').prop("checked", true); if (response.Result > 0) { if (response.Result == 1) { //nalert('Email already exists in SSO'); //$('#duplicateemail').html("Email already exists, please <a href='https://ebiz.nursingworld.org/SSO/login.aspx?vi=7&vt=26e3000358093dc2f7fa6bfb6bdbf446decd101d23a1c97bf9e46e3b3ddf469f2adb685af3314915b2c6ca6a037a5ed4394900d1d77390d20b13e4a6633d573519d459e6c8a5f279ddc55aea766e7fac52f64cb4bf8dd086f52c4ecf020578b5dd372c051553f3aab5a1799b5ba60508' class='btn btn-primary'>Sign In</a>"); $('#duplicateemail').html("We have found your account in our system, please enter payment information to complete the donation."); $('#existingemail, #sameasrow').hide(); $('#ccaddress').show(); } if (response.Result > 1) { //nalert('Email already exists in our system'); //$('#duplicateemail').html("Email already exists in our system, please contact 301-628-5227 to receive login credentials"); $('#duplicateemail').html("More than one account is associated with this email address, please login first."); $('#existingemail, #sameasrow').hide(); //$('#ccaddress').show(); $('#payments').hide(); $('#paymentbuttonrow').hide(); } } return false; }, error: function () { nalert('An error occurred verifying email'); return false; } }); } }, 1500); }); $('body').on('keyup', '#donationamount', function () { if (!isNumeric($(this).val())) { $(this).addClass('error'); } else { c = $(this).val(); if (!(c >= 1)) { $(this).addClass('error'); $('#donationamounterror').show(); } else { $(this).removeClass('error'); $('#donationamounterror').hide(); } } }); Number.prototype.formatMoney = function (c, d, t) { var n = this, c = isNaN(c = Math.abs(c)) ? 2 : c, d = d == undefined ? "." : d, t = t == undefined ? "," : t, s = n < 0 ? "-" : "", i = parseInt(n = Math.abs(+n || 0).toFixed(c)) + "", j = (j = i.length) > 3 ? j % 3 : 0; return s + (j ? i.substr(0, j) + t : "") + i.substr(j).replace(/(\d{3})(?=\d)/g, "$1" + t) + (c ? d + Math.abs(n - i).toFixed(c).slice(2) : ""); }; function TotalDonation() { $('#totaldonation').hide(); if ($('#repeatx:checked').length > 0 && $('#repeattime').val() > 0) { var x = $('#repeattime').val(); var d = $('#donationamount').val(); console.log(x, d, x * d); if (x * d > 0) { $('#totaldonation').html('Your total donation will be $' + (x * d * 12).formatMoney(2)).show(); } } return false; } $('body').on('click', '.repeat', function () { console.log('repeat'); $('#cclink').trigger('click'); if ($('#repeat1:checked').length > 0) { $('#repeattimeline').hide(); $('#echecklink').show(); $('#etflink').hide(); } else { $('#repeattimeline').show(); $('#echecklink').hide(); $('#etflink').show(); } setImpact(); TotalDonation(); //return false; }); $('body').on('change', '#repeattime', function () { console.log('repeattime'); setImpact(); TotalDonation(); //return false; }); function luhnCheck(value) { // accept only digits, dashes or spaces if (/[^0-9-\s]+/.test(value)) return false; // The Luhn Algorithm. It's so pretty. var nCheck = 0, nDigit = 0, bEven = false; value = value.replace(/\D/g, ""); for (var n = value.length - 1; n >= 0; n--) { var cDigit = value.charAt(n), nDigit = parseInt(cDigit, 10); if (bEven) { if ((nDigit *= 2) > 9) nDigit -= 9; } nCheck += nDigit; bEven = !bEven; } return (nCheck % 10) == 0; } $('body').on('click', '.process1', function () { console.log('process1'); //Captcha validate //var $captcha = $('#recaptcha'), // response = grecaptcha.getResponse(); //if (response.length === 0) { // if (!$captcha.hasClass("error")) { // $captcha.addClass("error"); // } //} else { // $captcha.removeClass("error"); //} //End Captcha var required = $('.required:visible'); $(required).removeClass('error'); var missing = $(required).filter(function () { return !$(this).val(); }); var errormessage = ''; if ($(missing).length > 0) { $(missing).addClass('error'); errormessage = 'Please fill in all of the required fields'; } else { //validate emails var email = $('.email:visible').filter(function () { return !isEmail($(this).val()); }); if ($(email).length > 0) { $(email).addClass('error'); errormessage = 'Invalid email'; } var number = $('.number:visible').filter(function () { return !isNumeric($(this).val()); }); if ($(number).length > 0) { $(number).addClass('error'); errormessage = 'Invalid number'; } var donationamount = $('#donationamount').val(); if (!(donationamount >= 1)) { $('#donationamount').addClass('error'); errormessage = "Minimum online donation amount is $1, please select or enter an amount"; nalert(errormessage); } if ($('#authorize:visible').length > 0) { if (!(($("#authorize:checked").length) > 0)) { $('#authorize').parent().addClass('requiredflag'); errormessage = 'Please authorize this transaction'; nalert(errormessage); return false; } } if ($('#cardnumber:visible').length > 0) { var cardnumber = $('#cardnumber').val(); var cardtype = GetCardType(cardnumber); if (!(cardtype.length > 0) || !(luhnCheck(cardnumber))) { $('#cardnumber').addClass('error'); errormessage = 'Invalid Credit Card Number'; nalert(errormessage); return false; } var cardmonth = $('#cardmonth').val(); var cardyear = $('#cardyear').val(); if (cardyear == new Date().getFullYear() && cardmonth < new Date().getMonth() + 1) { $('#cardmonth, #cardyear').addClass('error'); errormessage = 'Invalid Expiration Date'; nalert(errormessage); return false; } } if ($('#ssnNumber:visible').length > 0) { if (!isValidDate($('#dateOfBirth').val())) { $('#dateOfBirth').addClass('error'); errormessage = 'Invalid Date Of Birth'; nalert(errormessage); return false; } } } var error = $('.error:visible:first'); if (errormessage.length > 0 && $(error).length > 0) { $('html, body').animate({ scrollTop: $(error).offset().top - 100 }, 300); nalert(errormessage); return false; } console.log('process1 1'); if ($('#repeat1:checked').length > 0) { ProcessPayment(); } else { if ($('#repeattime').val() > 0) { if ($('#etfroutingnumber:visible').length > 0) { $('#myModalPledgeEFT').modal('show'); } else { $('#myModalPledgeCC').modal('show'); } } else { if ($('#etfroutingnumber:visible').length > 0) { $('#myModalMonthlyEFT').modal('show'); } else { $('#myModalMonthlyCC').modal('show'); } } } console.log('process1 end'); }); $('body').on('click', '.process2', function () { console.log('process2'); ProcessPayment(); }); $('body').on('click', '#dedicationforck', function () { console.log('dedicationfor'); if ($('#dedicationforck:checked').length > 0) { $('#dedicationfor').show(); } else { $('#dedicationfor').hide(); } }); $('body').on('click', '#on_behalf_company_ck', function () { console.log('on_behalf_company'); if ($('#on_behalf_company_ck:checked').length > 0) { $('#on_behalf_company').show(); } else { $('#on_behalf_company').hide(); } }); $('body').on('click', '#donationtock', function () { console.log('donationto'); if ($('#donationtock:checked').length > 0) { $('#donationto').show(); } else { $('#donationto').hide(); } }); function ProcessPayment() { FillAddress(); console.log("ProcessPayment"); $('#myModalMonthlyCC').modal('hide'); $('#myModalPledgeCC').modal('hide'); $('#myModalMonthlyEFT').modal('hide'); $('#myModalPledgeEFT').modal('hide'); var billing = { "prefix": $('#prefix2').val(), "firstname": $('#firstname2').val(), "middlename": $('#middlename2').val(), "lastname": $('#lastname2').val(), "credentials": $('#credentials2').val(), "company": $('#company2').val(), "email": $('#email2').val(), "phonecountry": $('#PHONECOUNTRY2').val(), "phonecountrycode": $('#PHONECOUNTRY2 option:selected').attr("property"), "phone_area_code": $('#PHONE_AREA_CODE2').val(), "phone_number": $('#PHONE_NUMBER1').val(), "country": $('#COUNTRY2').val(), "address_1": $('#ADDRESS_12').val(), "address_2": $('#ADDRESS_22').val(), "address_3": $('#ADDRESS_32').val(), "address_4": $('#ADDRESS_42').val(), "city": $('#CITY2').val(), "state": $('#STATE2').val(), "postal_code": $('#POSTAL_CODE2').val(), }; var card = {}; if ($('#cardnumber:visible').length > 0) { card = { "cardtype": GetCardType($('#cardnumber').val()), "cardnumber": $('#cardnumber').val(), "cardname": $('#cardname').val(), "cardmonth": $('#cardmonth').val(), "cardyear": $('#cardyear').val(), "cwcode": $('#cwcode').val(), "Address1": $('#ADDRESS_13').val(), "City": $('#CITY3').val(), "State": $('#STATE3').val(), "PostalCode": $('#POSTAL_CODE3').val(), "CountryCode": $('#COUNTRY3').val(), }; } var etf = {}; if ($('#etfroutingnumber:visible').length > 0) { etf = { "etfroutingnumber": $('#etfroutingnumber').val(), "etfinstitution": $('#etfinstitution').val(), "etfaccountnumber": $('#etfaccountnumber').val(), "etfaccounttype": $('#etfaccounttype').val(), }; } var echeck = {}; if ($('#echeckroutingnumber:visible').length > 0) { echeck = { "echeckroutingnumber": $('#echeckroutingnumber').val(), "echeckaccountnumber": $('#echeckaccountnumber').val(), "echecknumber": $('#echecknumber').val(), "echeckname": $('#echeckname').val(), "echeckIDType": $('echeckIDType').val(), "echeckidNumber": $('echeckidNumber').val(), "echeckstate": $('echeckstate').val(), "ssnNumber": $('ssnNumber').val(), "dateOfBirth": $('dateOfBirth').val(), }; } var notification = {}; if ($('#donationtock:checked').length > 0) { notification = { "prefix": $('#prefix1').val(), "firstname": $('#firstname1').val(), "middlename": $('#middlename1').val(), "lastname": $('#lastname1').val(), "email": $('#email1').val(), "company": $('#company1').val(), "phonecountry": $('#PHONECOUNTRY1').val(), "phonecountrycode": $('#PHONECOUNTRY1 option:selected').attr("property"), "phone_area_code": $('#PHONE_AREA_CODE1').val(), "phone_number": $('#PHONE_NUMBER1').val(), "country": $('#COUNTRY1').val(), "address_1": $('#ADDRESS_11').val(), "address_2": $('#ADDRESS_21').val(), "address_3": $('#ADDRESS_31').val(), "address_4": $('#ADDRESS_41').val(), "city": $('#CITY1').val(), "state": $('#STATE1').val(), "postal_code": $('#POSTAL_CODE1').val(), "anonymous": ($('#anonymous:checked').length > 0), } } var dedication = {}; if ($('#dedicationforck:checked').length > 0) { dedication = { "tributetype": ($('#honor:checked').length > 0) ? "IN_HONOR_OF" : "IN_MEMORY_OF", "tributename": $('#tributename').val(), "tributemessage": $('#tributemessage').val(), "notification": notification } } //ANA-1175 ANF donation enhancement var onbehalfCompany = {}; if ($('#on_behalf_company_ck:checked').length > 0) { onbehalfCompany = { "USR_COMPANY_NAME": $('#USR_COMPANY_NAME').val() } } var usrIsNurse = {"USR_IS_NURSE": 'Y'}; if ($('#usr_is_nurse_ck:checked').length > 0) { usrIsNurse = { "USR_IS_NURSE": 'Y' } } var data = { "donationamount": $('#donationamount').val(), "repeat": ($('#repeat1:checked').length > 0) ? "1" : "x", "repeattime": $('#repeattime').val(), "productid": $('.impact:visible').val(), 'dedication': dedication, 'billing': billing, 'card': card, 'etf': etf, 'echeck': echeck, 'onbehalfCompany': onbehalfCompany, //ANA-1175 ANF donation enhancement 'usrIsNurse': usrIsNurse, //xni 'GoogleCaptchaToken': document.getElementById("GoogleCaptchaToken").value }; console.log("data", data); $("#divForm").hide(); $("#imgLoading").show(); //save info $.ajax({ url: '/ANFDonation/SavePayment', contentType: "application/json; charset=utf-8", type: 'POST', dataType: "json", data: JSON.stringify(data), success: function (response) { console.log('Success', response); if (response != null && response.Success == true) { console.log("done"); location.href = '/ANFDonation/Confirmation'; } else { $("#divForm").show(); $("#imgLoading").hide(); if (response.Message != null && response.Message.length > 0) { nalert(response.Message); } else { nalert('An error occurred (1)'); } } return false; }, error: function () { $("#divForm").show(); $("#imgLoading").hide(); nalert('An error occurred (2)'); return false; } }); return false; }; }); </script> </div> <div class="container" id="noscript"> Seems your browsers Javascript is disabled. Please enable browser Javascript for this page to work correctly (properly). </div> <script> document.getElementById('noscript').style.display = 'none'; document.getElementById('script').style.display = 'block'; </script> <footer class="c-footer"> <div class="c-footer__wrap--dark cf"> <section class="c-footer__secondary"> <div class="c-footer__section c-footer__section--dark"> <section class="c-footer__content grid grid--full"> <div class="c-footer__content-item grid__item one-whole large--one-quarter"> </div> <div class="c-footer__content-item grid__item one-whole large--one-half push--large--one-quarter"> <aside class="c-footer__copyright"> <font size=1>©2019 the American Nurses Association, Inc. All rights reserved.</font> </aside> </div> </section> </div> </section> </div> </footer> </body> </html>

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