{"id":2936,"date":"2019-01-02T15:49:30","date_gmt":"2019-01-02T21:49:30","guid":{"rendered":"https:\/\/www.faceitfoundation.org\/?page_id=2936"},"modified":"2024-06-27T09:42:42","modified_gmt":"2024-06-27T14:42:42","slug":"legacy-donation-form","status":"publish","type":"page","link":"https:\/\/www.faceitfoundation.org\/legacy-of-hope-campaign\/legacy-donation-form\/","title":{"rendered":"Join the Legacy Campaign"},"content":{"rendered":"<p>All contributions to the Face It Foundation are tax deductible to the extent provided by law. Tax ID # 27-1391950.<\/p>\n<p>Questions?\u00a0 Contact Mark Meier at 651-200-4297 or <a href=\"mailto:mmeier@faceitfoundation.org\">mmeier@faceitfoundation.org<\/a>.<\/p>\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_10' style='display:none'><div id='gf_10' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_10' id='gform_10'  action='\/wp-json\/wp\/v2\/pages\/2936#gf_10' data-formid='10' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LdZG8goAAAAAF0PkkbSwIm7FysUGPM_PuYeuJxk' data-tabindex='1000'><input id=\"input_0ba02a04277c612cbf3a6cdb4174cdb9\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_0ba02a04277c612cbf3a6cdb4174cdb9\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_10_1\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Donor Information<\/h3><\/div><fieldset id=\"field_10_3\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/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_10_3'>\n                            \n                            <span id='input_10_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_10_3_3' value='' tabindex='1002'  aria-required='true'     \/>\n                                                    <label for='input_10_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_10_3_6' value='' tabindex='1004'  aria-required='true'     \/>\n                                                    <label for='input_10_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><\/fieldset><fieldset id=\"field_10_4\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_10_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_10_4_1_container' >\n                                        <input type='text' name='input_4.1' id='input_10_4_1' value='' tabindex='1006'   aria-required='false'    \/>\n                                        <label for='input_10_4_1' id='input_10_4_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_10_4_3_container' >\n                                    <input type='text' name='input_4.3' id='input_10_4_3' value='' tabindex='1007'   aria-required='false'    \/>\n                                    <label for='input_10_4_3' id='input_10_4_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_10_4_4_container' >\n                                        <select name='input_4.4' id='input_10_4_4' tabindex='1008'    aria-required='false'    ><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='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='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/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><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><\/select>\n                                        <label for='input_10_4_4' id='input_10_4_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_10_4_5_container' >\n                                    <input type='text' name='input_4.5' id='input_10_4_5' value='' tabindex='1010'   aria-required='false'    \/>\n                                    <label for='input_10_4_5' id='input_10_4_5_label' class='gform-field-label gform-field-label--type-sub '>Zip<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_4.6' id='input_10_4_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><\/fieldset><div id=\"field_10_5\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_5'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_5' id='input_10_5' type='email' value='' class='medium' tabindex='1011'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_10_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >My gift will be matched<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_6'>\n\t\t\t<div class='gchoice gchoice_10_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Yes'  id='choice_10_6_0' onchange='gformToggleRadioOther( this )'  tabindex='1012'  \/>\n\t\t\t\t\t<label for='choice_10_6_0' id='label_10_6_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='No' checked='checked' id='choice_10_6_1' onchange='gformToggleRadioOther( this )'  tabindex='1013'  \/>\n\t\t\t\t\t<label for='choice_10_6_1' id='label_10_6_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><div id=\"field_10_7\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_7'>Company Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_10_7' type='text' value='' class='medium'   tabindex='1014'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_2\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Pledge Information<\/h3><\/div><div id=\"field_10_8\" class=\"gfield gfield--type-product gfield--input-type-price gfield_price gfield_price_10_8 gfield_product_10_8 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_8'>I am proud to support the Face It Legacy Campaign in the amount of:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_product_price'>\n\t\t\t\t\t<input name='input_8' id='input_10_8' type='text' value='' class='small ginput_amount' tabindex='1015'  aria-required=\"true\" aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/div><fieldset id=\"field_10_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >This is a one-time donation:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_9'>\n\t\t\t<div class='gchoice gchoice_10_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Yes'  id='choice_10_9_0' onchange='gformToggleRadioOther( this )'  tabindex='1016'  \/>\n\t\t\t\t\t<label for='choice_10_9_0' id='label_10_9_0' class='gform-field-label gform-field-label--type-inline'>Yes, I would like to pay one lump sum.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='No'  id='choice_10_9_1' onchange='gformToggleRadioOther( this )'  tabindex='1017'  \/>\n\t\t\t\t\t<label for='choice_10_9_1' id='label_10_9_1' class='gform-field-label gform-field-label--type-inline'>No, I'd like to pay over a period of 1-5 years.<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><fieldset id=\"field_10_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Payment Period<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_13'>\n\t\t\t<div class='gchoice gchoice_10_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='1'  id='choice_10_13_0' onchange='gformToggleRadioOther( this )'  tabindex='1018'  \/>\n\t\t\t\t\t<label for='choice_10_13_0' id='label_10_13_0' class='gform-field-label gform-field-label--type-inline'>1 Year<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='2'  id='choice_10_13_1' onchange='gformToggleRadioOther( this )'  tabindex='1019'  \/>\n\t\t\t\t\t<label for='choice_10_13_1' id='label_10_13_1' class='gform-field-label gform-field-label--type-inline'>2 Years<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_13_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='3'  id='choice_10_13_2' onchange='gformToggleRadioOther( this )'  tabindex='1020'  \/>\n\t\t\t\t\t<label for='choice_10_13_2' id='label_10_13_2' class='gform-field-label gform-field-label--type-inline'>3 Years<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_13_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='4'  id='choice_10_13_3' onchange='gformToggleRadioOther( this )'  tabindex='1021'  \/>\n\t\t\t\t\t<label for='choice_10_13_3' id='label_10_13_3' class='gform-field-label gform-field-label--type-inline'>4 Years<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_13_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='5'  id='choice_10_13_4' onchange='gformToggleRadioOther( this )'  tabindex='1022'  \/>\n\t\t\t\t\t<label for='choice_10_13_4' id='label_10_13_4' class='gform-field-label gform-field-label--type-inline'>5 Years<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><fieldset id=\"field_10_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Bill Me<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_14'>\n\t\t\t<div class='gchoice gchoice_10_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Annually'  id='choice_10_14_0' onchange='gformToggleRadioOther( this )'  tabindex='1023'  \/>\n\t\t\t\t\t<label for='choice_10_14_0' id='label_10_14_0' class='gform-field-label gform-field-label--type-inline'>Annually<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Quarterly'  id='choice_10_14_1' onchange='gformToggleRadioOther( this )'  tabindex='1024'  \/>\n\t\t\t\t\t<label for='choice_10_14_1' id='label_10_14_1' class='gform-field-label gform-field-label--type-inline'>Quarterly<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_14_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Monthly'  id='choice_10_14_2' onchange='gformToggleRadioOther( this )'  tabindex='1025'  \/>\n\t\t\t\t\t<label for='choice_10_14_2' id='label_10_14_2' class='gform-field-label gform-field-label--type-inline'>Monthly<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><div id=\"field_10_15\" class=\"gfield gfield--type-product gfield--input-type-calculation gfield_price gfield_price_10_15 gfield_product_10_15 gfield_contains_required gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_10_15_1'>Recurring Payment Amount (Annual)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_product_calculation'>\n\t\t\t\t\t<input type='hidden' name='input_15.1' value='Recurring Payment Amount (Annual)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_10_15' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<label class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_10_15'>$0.00<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_15.2' id='ginput_base_price_10_15' class='gform_hidden ginput_calculated_price' value='$0.00'\/>\n\t\t\t\t\t<input type='hidden' name='input_15.3' value='1' class='ginput_quantity_10_15 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_10_16\" class=\"gfield gfield--type-product gfield--input-type-calculation gfield_price gfield_price_10_16 gfield_product_10_16 gfield_contains_required gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_10_16_1'>Recurring Payment Amount (Quarterly)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_product_calculation'>\n\t\t\t\t\t<input type='hidden' name='input_16.1' value='Recurring Payment Amount (Quarterly)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_10_16' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<label class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_10_16'>$0.00<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_16.2' id='ginput_base_price_10_16' class='gform_hidden ginput_calculated_price' value='$0.00'\/>\n\t\t\t\t\t<input type='hidden' name='input_16.3' value='1' class='ginput_quantity_10_16 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_10_17\" class=\"gfield gfield--type-product gfield--input-type-calculation gfield_price gfield_price_10_17 gfield_product_10_17 gfield_contains_required gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_10_17_1'>Recurring Payment Amount (Monthly)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container 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