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menu-item-has-children menu-item-1655"><a href="#">Corporate</a> <ul class="sub-menu"> <li class="et_pb_menu_page_id-22954 menu-item menu-item-type-custom menu-item-object-custom menu-item-22954"><a href="https://eangus.org/wp-content/uploads/2025/02/2025-EANGUS-PROSPECTUS-FINAL.pdf">2025 Prospectus</a></li> <li class="second-level et_pb_menu_page_id-11349 menu-item menu-item-type-post_type menu-item-object-page menu-item-11401"><a href="https://eangus.org/corporate-partnership-information/">Corporate Partnership</a></li> <li class="second-level et_pb_menu_page_id-17726 menu-item menu-item-type-post_type menu-item-object-page menu-item-17730"><a href="https://eangus.org/eangus-corporate-advisory-panel/">EANGUS Corporate Advisory Panel</a></li> </ul> </li> <li class="first-level et_pb_menu_page_id-11571 menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-11571"><a href="#">Council</a> <ul class="sub-menu"> <li class="et_pb_menu_page_id-3 menu-item menu-item-type-post_type menu-item-object-page menu-item-22754"><a href="https://eangus.org/login/">Log In/Out</a></li> <li class="second-level et_pb_menu_page_id-11568 menu-item menu-item-type-post_type menu-item-object-page menu-item-11572"><a href="https://eangus.org/board-library/">Board Library</a></li> <li class="second-level et_pb_menu_page_id-32 menu-item menu-item-type-post_type menu-item-object-page menu-item-11574"><a href="https://eangus.org/ec-new-business/">EC New Business</a></li> <li class="et_pb_menu_page_id-19826 menu-item menu-item-type-post_type menu-item-object-page menu-item-19836"><a href="https://eangus.org/motion/">Submit a Motion</a></li> <li class="et_pb_menu_page_id-19835 menu-item menu-item-type-custom menu-item-object-custom menu-item-19835"><a href="https://dev.eangus.org/view/19831/">List of Motions</a></li> <li class="second-level et_pb_menu_page_id-18037 menu-item menu-item-type-custom menu-item-object-custom menu-item-18037"><a href="https://drive.google.com/file/d/1qh2W1I6lKtwbkxT2TEKA2rS0KZ__jQCs/view?usp=share_link">Chief Smith Video</a></li> <li class="second-level et_pb_menu_page_id-8480 menu-item menu-item-type-post_type menu-item-object-page menu-item-8482"><a href="https://eangus.org/mobile-app-payment-form/">Mobile App Payment Form</a></li> <li class="second-level et_pb_menu_page_id-9144 menu-item menu-item-type-post_type menu-item-object-page menu-item-9146"><a href="https://eangus.org/website-domain-renewal/">Website Domain Renewal</a></li> </ul> </li> </ul></nav> </div> <div class="et_mobile_nav_menu"> <div class="mobile_nav closed"> <span class="mobile_menu_bar"></span> </div> </div> </div> </div> </div> </div> </div> </div> </div> </header> <div id="et-main-area"> <div id="main-content"> <article id="post-15801" class="post-15801 page type-page status-publish has-post-thumbnail hentry pmpro-has-access"> <div class="entry-content"> <div class="et-l et-l--post"> <div class="et_builder_inner_content et_pb_gutters3"><div class="et_pb_section et_pb_section_0 et_section_regular" > <div class="et_pb_row et_pb_row_0"> <div class="et_pb_column et_pb_column_4_4 et_pb_column_0 et_pb_css_mix_blend_mode_passthrough et-last-child"> <div class="et_pb_module et_pb_text et_pb_text_0 et_pb_text_align_left et_pb_bg_layout_light"> <div class="et_pb_text_inner"><p>This payment portal is for State Association “Use Only” for paying monthly National Dues owed.</p> <p>As a reminder, the following changes are made concerning membership per the EANGUS bylaws that were adopted at the National Conference in Rochester, MN in August of 2023.</p> <p style="line-height: 160%;"><span style="font-size: 9.0pt; line-height: 160%; font-family: 'Arial',sans-serif; color: black;">1) <strong><span style="font-family: 'Arial',sans-serif;">ENLISTED</span></strong> <strong><span style="font-family: 'Arial',sans-serif;">ANNUAL MEMBERSHIP: $13.00</span></strong> (Effective January 1, 2024) </span><span style="font-size: 10.5pt; line-height: 160%; font-family: 'Arial',sans-serif; color: black;"><br /></span><span style="font-size: 9.0pt; line-height: 160%; font-family: 'Arial',sans-serif; color: black;">2) <strong><span style="font-family: 'Arial',sans-serif;">ENLISTED LIFE MEMBERSHIP: $130</span></strong> – Ten (10) times the ENLISTED ANNUAL MEMBERSHIP rate paid in advance. </span><span style="font-size: 10.5pt; line-height: 160%; font-family: 'Arial',sans-serif; color: black;"><br /></span><span style="font-size: 9.0pt; line-height: 160%; font-family: 'Arial',sans-serif; color: black;">3) <strong><span style="font-family: 'Arial',sans-serif;">ENLISTED “NEW TO THE EANGUS” DIGITAL ANNUAL MEMBERSHIP: $0.00</span></strong> </span><span style="font-size: 10.5pt; line-height: 160%; font-family: 'Arial',sans-serif; color: black;"><br /></span><span style="font-size: 9.0pt; line-height: 160%; font-family: 'Arial',sans-serif; color: black;">4) <strong><span style="font-family: 'Arial',sans-serif;">ASSOCIATE ANNUAL MEMBERSHIP: $13.00</span></strong> (Effective January 1, 2024) </span><span style="font-size: 10.5pt; line-height: 160%; font-family: 'Arial',sans-serif; color: black;"><br /></span><span style="font-size: 9.0pt; line-height: 160%; font-family: 'Arial',sans-serif; color: black;">5) <strong><span style="font-family: 'Arial',sans-serif;">ASSOCIATE LIFE MEMBERSHIP: $130</span></strong> – Ten (10) times the ASSOCIATE ANNUAL MEMBERSHIP rate paid in advance.</span></p> <p>Please ensure your National Membership Dues are paid every month by running your payment Orders report at the end of each month. Then attach that spreadsheet report of all the members that joined or renewed that month/s to this Form. Per EANGUS Membership Committee Policy you have 30 days grace period to pay for National Dues once the month in question ends. Members are not covered by the $2500 AD&D insurance policy until EANGUS receives their name and address along with payment.</p> <p><a href="https://eangus.org/wp-content/uploads/2024/11/National-Dues_Run-Order-Report.pdf" target="_blank" rel="noopener"><strong>Click Here: Instructions on How to Run a Payment Orders Report</strong></a></p> <p> <div class='gf_browser_ie gf_browser_ie7 gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_132' style='display:none'> <div class='gform_heading'> <h2 class="gform_title">National Dues Payment Portal</h2> <p class='gform_description'>.</p> </div><form method='post' enctype='multipart/form-data' id='gform_132' action='/dues-portal/' data-formid='132' novalidate> <div class='gform-body gform_body'><div id='gform_fields_132' class='gform_fields right_label form_sublabel_below description_below validation_below'><fieldset id="field_132_4" class="gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_132_4" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name on credit card or Bank Account<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_132_4'> <span id='input_132_4_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' > <input type='text' name='input_4.3' id='input_132_4_3' value='' aria-required='true' /> <label for='input_132_4_3' class='gform-field-label gform-field-label--type-sub '>First</label> </span> <span id='input_132_4_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' > <input type='text' name='input_4.6' id='input_132_4_6' value='' aria-required='true' /> <label for='input_132_4_6' class='gform-field-label gform-field-label--type-sub '>Last</label> </span> </div></fieldset><fieldset id="field_132_21" class="gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_132_21" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Billing Address<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend> <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_132_21' > <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_132_21_1_container' > <input type='text' name='input_21.1' id='input_132_21_1' value='' aria-required='true' /> <label for='input_132_21_1' id='input_132_21_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address</label> </span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_132_21_2_container' > <input type='text' name='input_21.2' id='input_132_21_2' value='' aria-required='false' /> <label for='input_132_21_2' id='input_132_21_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2</label> </span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_132_21_3_container' > <input type='text' name='input_21.3' id='input_132_21_3' value='' aria-required='true' /> <label for='input_132_21_3' id='input_132_21_3_label' class='gform-field-label gform-field-label--type-sub '>City</label> </span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_132_21_4_container' > <select name='input_21.4' id='input_132_21_4' aria-required='true' ><option value='' selected='selected'></option><option value='Alabama' >Alabama</option><option value='Alaska' >Alaska</option><option value='American Samoa' >American Samoa</option><option value='Arizona' >Arizona</option><option value='Arkansas' >Arkansas</option><option value='Armed Forces Americas' >Armed Forces Americas</option><option value='Armed Forces Europe' >Armed Forces Europe</option><option value='Armed Forces Pacific' >Armed Forces Pacific</option><option value='California' >California</option><option value='Colorado' >Colorado</option><option value='Connecticut' >Connecticut</option><option value='Delaware' >Delaware</option><option value='District of Columbia' >District of Columbia</option><option value='Florida' >Florida</option><option value='Georgia' >Georgia</option><option value='Guam' >Guam</option><option value='Hawaii' >Hawaii</option><option value='Idaho' >Idaho</option><option value='Illinois' >Illinois</option><option value='Indiana' >Indiana</option><option value='Iowa' >Iowa</option><option value='Kansas' >Kansas</option><option value='Kentucky' >Kentucky</option><option value='Louisiana' >Louisiana</option><option value='Maine' >Maine</option><option value='Maryland' >Maryland</option><option value='Massachusetts' >Massachusetts</option><option value='Michigan' >Michigan</option><option value='Minnesota' >Minnesota</option><option value='Mississippi' >Mississippi</option><option value='Missouri' >Missouri</option><option value='Montana' >Montana</option><option value='Nebraska' >Nebraska</option><option value='Nevada' >Nevada</option><option value='New Hampshire' >New Hampshire</option><option value='New Jersey' >New Jersey</option><option value='New Mexico' >New Mexico</option><option value='New York' >New York</option><option value='North Carolina' >North Carolina</option><option value='North Dakota' >North Dakota</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Ohio' >Ohio</option><option value='Oklahoma' >Oklahoma</option><option value='Oregon' >Oregon</option><option value='Pennsylvania' >Pennsylvania</option><option value='Puerto Rico' >Puerto Rico</option><option value='Rhode Island' >Rhode Island</option><option value='South Carolina' >South Carolina</option><option value='South Dakota' >South Dakota</option><option value='Tennessee' >Tennessee</option><option value='Texas' >Texas</option><option value='U.S. Virgin Islands' >U.S. Virgin Islands</option><option value='US Virgin Islands' >US Virgin Islands</option><option value='Utah' >Utah</option><option value='Vermont' >Vermont</option><option value='Virginia' >Virginia</option><option value='Washington' >Washington</option><option value='West Virginia' >West Virginia</option><option value='Wisconsin' >Wisconsin</option><option value='Wyoming' >Wyoming</option></select> <label for='input_132_21_4' id='input_132_21_4_label' class='gform-field-label gform-field-label--type-sub '>State</label> </span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_132_21_5_container' > <input type='text' name='input_21.5' id='input_132_21_5' value='' aria-required='true' /> <label for='input_132_21_5' id='input_132_21_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code</label> </span><input type='hidden' class='gform_hidden' name='input_21.6' id='input_132_21_6' value='United States' /> <div class='gf_clear gf_clear_complex'></div> </div></fieldset><div id="field_132_6" class="gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_132_6" ><label class='gfield_label gform-field-label' for='input_132_6'>State Association<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_select'><select name='input_6' id='input_132_6' class='small gfield_select' aria-required="true" aria-invalid="false" ><option value='Select' >Select</option><option value='ENGAA (AL)' >ENGAA (AL)</option><option value='ANGEA (AK)' >ANGEA (AK)</option><option value='EANGA (AZ)' >EANGA (AZ)</option><option value='EAANG (AR)' >EAANG (AR)</option><option value='CALEANGUS (CA)' >CALEANGUS (CA)</option><option value='NGACO (CO)' >NGACO (CO)</option><option value='NGACT (CT)' >NGACT (CT)</option><option value='DENGEA (DE)' >DENGEA (DE)</option><option value='DCNGEA (DC)' >DCNGEA (DC)</option><option value='NGAFL (FL)' >NGAFL (FL)</option><option value='EANGGA (GA)' >EANGGA (GA)</option><option value='GUNGEA (GU)' >GUNGEA (GU)</option><option value='HNGEA (HI)' >HNGEA (HI)</option><option value='IDNGEA (ID)' >IDNGEA (ID)</option><option value='NGAI (ILLINOIS)' >NGAI (ILLINOIS)</option><option value='NGAI (INDIANA)' >NGAI (INDIANA)</option><option value='EANGI (IA)' >EANGI (IA)</option><option value='EANGKS (KS)' >EANGKS (KS)</option><option value='EANGKY (KY)' >EANGKY (KY)</option><option value='LANGEA (LA)' >LANGEA (LA)</option><option value='MENGEA (ME)' >MENGEA (ME)</option><option value='MDEANGUS (MD)' >MDEANGUS (MD)</option><option value='MNGEA (MASSACHUSETTS)' >MNGEA (MASSACHUSETTS)</option><option value='NGAM (MI)' >NGAM (MI)</option><option value='MNGEA (MINNESOTA)' >MNGEA (MINNESOTA)</option><option value='EANGMS (MS)' >EANGMS (MS)</option><option value='MONGA (MO)' >MONGA (MO)</option><option value='MTEANG (MT)' >MTEANG (MT)</option><option value='NENGEA (NE)' >NENGEA (NE)</option><option value='NVEANG (NV)' >NVEANG (NV)</option><option value='NHNGEA (NH)' >NHNGEA (NH)</option><option value='EANGNJ (NJ)' >EANGNJ (NJ)</option><option value='EANMNG (NM)' >EANMNG (NM)</option><option value='EANYNG (NY)' >EANYNG (NY)</option><option value='NCNGA (NC)' >NCNGA (NC)</option><option value='NDNGEA (ND)' >NDNGEA (ND)</option><option value='ONGEA (OH)' >ONGEA (OH)</option><option value='NGAOK (OK)' >NGAOK (OK)</option><option value='EANGOR (OR)' >EANGOR (OR)</option><option value='PNGEA (PA)' >PNGEA (PA)</option><option value='PRNGEA (PR)' >PRNGEA (PR)</option><option value='RINGEA (RI)' >RINGEA (RI)</option><option value='NGASC (SC)' >NGASC (SC)</option><option value='SDNGEA (SD)' >SDNGEA (SD)</option><option value='EANGTN (TN)' >EANGTN (TN)</option><option value='NGAT (TX)' >NGAT (TX)</option><option value='NGB TITLE-10 (NG)' >NGB TITLE-10 (NG)</option><option value='EANGUT (UT)' >EANGUT (UT)</option><option value='VTNGEA (VT)' >VTNGEA (VT)</option><option value='VAAANGEA (VA)' >VAAANGEA (VA)</option><option value='VIEANG (VI)' >VIEANG (VI)</option><option value='NGAW (WA)' >NGAW (WA)</option><option value='EANGWV (WV)' >EANGWV (WV)</option><option value='WNGEA (WI)' >WNGEA (WI)</option><option value='WYNGA (WY)' >WYNGA (WY)</option></select></div></div><div id="field_132_7" class="gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_132_7" ><label class='gfield_label gform-field-label' for='input_132_7'>How many Annual?<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_132_7' type='text' value='' class='small' aria-describedby="gfield_description_132_7" aria-required="true" aria-invalid="false" /></div><div class='gfield_description' id='gfield_description_132_7'>If None Enter "0"</div></div><div id="field_132_8" class="gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_132_8" ><label class='gfield_label gform-field-label' for='input_132_8'>How many Life?<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_132_8' type='text' value='' class='small' aria-describedby="gfield_description_132_8" aria-required="true" aria-invalid="false" /></div><div class='gfield_description' id='gfield_description_132_8'>If None Enter "0"</div></div><div id="field_132_9" class="gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_132_9" ><label class='gfield_label gform-field-label' for='input_132_9'>How many Associate?<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_132_9' type='text' value='' class='small' aria-describedby="gfield_description_132_9" aria-required="true" aria-invalid="false" /></div><div class='gfield_description' id='gfield_description_132_9'>If None Enter "0"</div></div><div id="field_132_18" class="gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_132_18" ><label class='gfield_label gform-field-label' for='input_132_18'>How many Life Installments?<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_132_18' type='text' value='' class='small' aria-describedby="gfield_description_132_18" aria-required="true" aria-invalid="false" /></div><div class='gfield_description' id='gfield_description_132_18'>If None Enter "0"</div></div><div id="field_132_10" class="gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_132_10" ><label class='gfield_label gform-field-label' for='input_132_10'>Phone<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_phone'><input name='input_10' id='input_132_10' type='tel' value='' class='small' aria-required="true" aria-invalid="false" /></div></div><div id="field_132_11" class="gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_132_11" ><label class='gfield_label gform-field-label' for='input_132_11'>Email<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_11' id='input_132_11' type='email' value='' class='small' aria-required="true" aria-invalid="false" /> </div></div><div id="field_132_16" class="gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_132_16" ><h3 class="gsection_title">Documentation Uploads</h3><div class='gsection_description' id='gfield_description_132_16'>If you receive an error when uploading, email spreadsheet to bryan@eangus.org</div></div><div id="field_132_17" class="gfield gfield--type-fileupload gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_132_17" ><label class='gfield_label gform-field-label' for='input_132_17'>Spreadsheet File Upload</label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='131072000' /><input name='input_17' id='input_132_17' type='file' class='large' aria-describedby="gfield_upload_rules_132_17 gfield_description_132_17" onchange='javascript:gformValidateFileSize( this, 131072000 );' /><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_132_17'>Max. file size: 125 MB.</span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_132_17'></div></div><div class='gfield_description' id='gfield_description_132_17'>Upload payment "Orders" spreadsheet for the month/s in question.</div></div><div id="field_132_12" class="gfield gfield--type-product gfield--input-type-price gfield_price gfield_price_132_12 gfield_product_132_12 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_132_12" ><label class='gfield_label gform-field-label' for='input_132_12'>Total Dues Paid<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_product_price'> <input name='input_12' id='input_132_12' type='text' value='' class='small ginput_amount' aria-required="true" aria-invalid="false" /> </div></div><fieldset id="field_132_19" class="gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_132_19" ><legend class='gfield_label gform-field-label' >Payment Method<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_132_19'> <div class='gchoice gchoice_132_19_0'> <input class='gfield-choice-input' name='input_19' type='radio' value='Bank Draft' id='choice_132_19_0' onchange='gformToggleRadioOther( this )' /> <label for='choice_132_19_0' id='label_132_19_0' class='gform-field-label gform-field-label--type-inline'>Bank Draft</label> </div> <div class='gchoice gchoice_132_19_1'> <input class='gfield-choice-input' name='input_19' type='radio' value='Credit Card' id='choice_132_19_1' onchange='gformToggleRadioOther( this )' /> <label for='choice_132_19_1' id='label_132_19_1' class='gform-field-label gform-field-label--type-inline'>Credit Card</label> </div></div></div></fieldset><div id="field_132_13" class="gfield gfield--type-total gfield--width-full gfield_price gfield_price_132_ gfield_total gfield_total_132_ field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" aria-atomic="true" aria-live="polite" data-js-reload="field_132_13" ><label class='gfield_label gform-field-label' for='input_132_13'>Total</label><div class='ginput_container ginput_container_total'> <input type='text' readonly name='input_13' id='input_132_13' value='$0.00' class='gform-text-input-reset ginput_total ginput_total_132' /> </div></div><div id="field_132_15" class="gfield gfield--type-captcha gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_132_15" ><label class='gfield_label gform-field-label' for='input_132_15'>CAPTCHA</label><div id='input_132_15' class='ginput_container ginput_recaptcha' data-sitekey='6LeIVxAUAAAAAH4FR3vrZ_aIbofWRVF3XadL4aLH' data-theme='light' data-tabindex='0' data-badge=''></div></div><fieldset id="field_132_20" class="gfield gfield--type-ach gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_132_20" ><legend class='gfield_label gfield_label_before_complex' >ACH</legend><div class='ginput_complex ginput_container ginput_container_ach' id='input_132_20'><span class='ginput_left' id='input_132_20_1_container' > <input type='text' id='input_132_20_1' value='' autocomplete='off' pattern='[0-9]*' title='Only digits are allowed' aria-required='false' /> <label for='input_132_20_1' id='input_132_20_1_label' >Account Number</label> </span><span class='ginput_right' id='input_132_20_3_container'> <select name='input_20.3' id='input_132_20_3' class='ginput_card_expiration' aria-required='false' > <option value=''>Select</option><option value='S' >Savings</option><option value='C' >Checking</option> </select> <label for='input_132_20_3' id='input_132_20_3_label' >Account Type</label> </span><span class='ginput_full' id='input_132_20_2_container' > <input type='text' id='input_132_20_2' value='' autocomplete='off' pattern='[0-9]*' title='Only digits are allowed' aria-required='false' /> <label for='input_132_20_2' 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