{"id":409,"date":"2023-08-07T15:16:04","date_gmt":"2023-08-07T19:16:04","guid":{"rendered":"https:\/\/paybms.com\/cfm\/?page_id=409"},"modified":"2023-08-09T09:54:20","modified_gmt":"2023-08-09T13:54:20","slug":"membership-form","status":"publish","type":"page","link":"https:\/\/paybms.com\/cfm\/membership-form\/","title":{"rendered":"Membership Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"409\" class=\"elementor elementor-409\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2d9c1a9 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2d9c1a9\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e1545b3\" data-id=\"e1545b3\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-70f9fb6 elementor-widget elementor-widget-image\" data-id=\"70f9fb6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/committeeformontgomery.org\">\n\t\t\t\t\t\t\t<img decoding=\"async\" width=\"209\" height=\"193\" src=\"https:\/\/paybms.com\/cfm\/wp-content\/uploads\/sites\/6\/2022\/11\/logo.jpg\" class=\"attachment-medium size-medium wp-image-288\" alt=\"\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0413491 elementor-widget elementor-widget-facebook-button\" data-id=\"0413491\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"facebook-button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div data-layout=\"standard\" data-colorscheme=\"light\" data-size=\"small\" data-show-faces=\"false\" class=\"elementor-facebook-widget fb-like\" data-href=\"https:\/\/paybms.com\/cfm?p=409\" data-share=\"false\" data-action=\"like\"><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-dcbc581 elementor-widget elementor-widget-image\" data-id=\"dcbc581\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"547\" height=\"171\" src=\"https:\/\/paybms.com\/cfm\/wp-content\/uploads\/sites\/6\/2023\/08\/Doc1222.jpeg\" class=\"attachment-large size-large wp-image-457\" alt=\"\" srcset=\"https:\/\/paybms.com\/cfm\/wp-content\/uploads\/sites\/6\/2023\/08\/Doc1222.jpeg 547w, https:\/\/paybms.com\/cfm\/wp-content\/uploads\/sites\/6\/2023\/08\/Doc1222-300x94.jpeg 300w\" sizes=\"(max-width: 547px) 100vw, 547px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-6c75129 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"6c75129\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-9f8ba4d\" data-id=\"9f8ba4d\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5f353c9 elementor-widget elementor-widget-wpforms\" data-id=\"5f353c9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wpforms-container wpforms-container-full wpforms-authorize_net\" id=\"wpforms-398\"><form id=\"wpforms-form-398\" class=\"wpforms-validate wpforms-form\" data-formid=\"398\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/cfm\/wp-json\/wp\/v2\/pages\/409\" data-token=\"c823b700f9978445728a3d67f4b2dec7\" data-token-time=\"1793623358\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#72b239\" data-scroll=\"1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> - <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of 3<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:33.333333333333%;background-color:#72b239\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-398-field_62-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"62\"><\/div><div id=\"wpforms-398-field_4-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"4\"><h3 id=\"wpforms-398-field_4\">Member Information<\/h3><\/div><div id=\"wpforms-398-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"0\"><label class=\"wpforms-field-label\">Primary Contact <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-398-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" required><label for=\"wpforms-398-field_0\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-398-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" required><label for=\"wpforms-398-field_0-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-398-field_33-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-398-field_33\">Position <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-398-field_33\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][33]\" required><\/div><div id=\"wpforms-398-field_56-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"56\"><label class=\"wpforms-field-label\" for=\"wpforms-398-field_56\">Business\/Organization\/Non-Profit Name<\/label><input type=\"text\" id=\"wpforms-398-field_56\" class=\"wpforms-field-medium\" name=\"wpforms[fields][56]\" ><\/div><div id=\"wpforms-398-field_3-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-398-field_3\">Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-398-field_3\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][3]\" aria-label=\"Phone\" required><\/div><div id=\"wpforms-398-field_55-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"55\"><label class=\"wpforms-field-label\" for=\"wpforms-398-field_55\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-398-field_55\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][55]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-398-field_34-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"34\"><label class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-398-field_34\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][34][address1]\" required><label for=\"wpforms-398-field_34\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-398-field_34-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][34][address2]\" ><label for=\"wpforms-398-field_34-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-398-field_34-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][34][city]\" required><label for=\"wpforms-398-field_34-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-398-field_34-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][34][state]\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-398-field_34-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-398-field_34-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][34][postal]\" required><label for=\"wpforms-398-field_34-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-398-field_61-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"61\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"398\" disabled>Next<\/button><img decoding=\"async\" src=\"https:\/\/paybms.com\/cfm\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-398-field_65-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"65\"><h3 id=\"wpforms-398-field_65\">Additional Information <\/h3><\/div><div id=\"wpforms-398-field_13-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"13\"><label class=\"wpforms-field-label\">How did you hear about us? (Select all that apply) <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-398-field_13\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-398-field_13_1\" name=\"wpforms[fields][13][]\" value=\"From a current or past member\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-398-field_13_1\">From a current or past member<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-398-field_13_2\" name=\"wpforms[fields][13][]\" value=\"Attended an event in the community\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-398-field_13_2\">Attended an event in the community<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-398-field_13_4\" name=\"wpforms[fields][13][]\" value=\"Search engine result\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-398-field_13_4\">Search engine result<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-398-field_13_5\" name=\"wpforms[fields][13][]\" value=\"Website\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-398-field_13_5\">Website<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-398-field_13_6\" name=\"wpforms[fields][13][]\" value=\"Social Media\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-398-field_13_6\">Social Media<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-398-field_13_7\" name=\"wpforms[fields][13][]\" value=\"Other\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-398-field_13_7\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-398-field_40-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"40\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-398-field_40\">Other (please specify):<\/label><input type=\"text\" id=\"wpforms-398-field_40\" class=\"wpforms-field-medium\" name=\"wpforms[fields][40]\" ><\/div><div id=\"wpforms-398-field_14-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"14\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-398-field_14\">Name of the person who referred you<\/label><input type=\"text\" id=\"wpforms-398-field_14\" class=\"wpforms-field-medium\" name=\"wpforms[fields][14]\" ><\/div><div id=\"wpforms-398-field_67-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"67\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"2\" data-formid=\"398\" disabled>Next<\/button><img decoding=\"async\" src=\"https:\/\/paybms.com\/cfm\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3 last \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-398-field_66-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"66\"><h3 id=\"wpforms-398-field_66\">Billing Information<\/h3><\/div><div id=\"wpforms-398-field_52-container\" class=\"wpforms-field wpforms-field-payment-multiple\" data-field-type=\"payment-multiple\" data-field-id=\"52\"><label class=\"wpforms-field-label\">Dues <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-398-field_52\" class=\"wpforms-field-required\"><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-398-field_52_3\" class=\"wpforms-payment-price\" data-amount=\"300.00\" name=\"wpforms[fields][52]\" value=\"3\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-398-field_52_3\">1 Year Membership - <span class=\"wpforms-currency-symbol\">&#036;300.00<\/span><\/label><\/li><li class=\"choice-5\"><input type=\"radio\" id=\"wpforms-398-field_52_5\" class=\"wpforms-payment-price\" data-amount=\"600.00\" name=\"wpforms[fields][52]\" value=\"5\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-398-field_52_5\">2 Year Membership - <span class=\"wpforms-currency-symbol\">&#036;600.00<\/span><\/label><\/li><\/ul><\/div><div id=\"wpforms-398-field_59-container\" class=\"wpforms-field wpforms-field-payment-single\" data-field-type=\"payment-single\" data-field-id=\"59\"><label class=\"wpforms-field-label\" for=\"wpforms-398-field_59\">Donation<\/label><input type=\"text\" id=\"wpforms-398-field_59\" class=\"wpforms-field-medium wpforms-payment-user-input wpforms-payment-price\" data-rule-currency=\"[&quot;$&quot;,false]\" name=\"wpforms[fields][59]\"><div class=\"wpforms-field-description\">We sincerely appreciate any additional donation you wish to make, it will have a meaningful impact on our mission.<\/div><\/div><div id=\"wpforms-398-field_48-container\" class=\"wpforms-field wpforms-field-authorize_net\" data-field-type=\"authorize_net\" data-field-id=\"48\"><label class=\"wpforms-field-label\">Credit Card Information <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-authorize_net-number\"><input type=\"text\" id=\"wpforms-398-field_48\" class=\"wpforms-field-authorize_net-cardnumber wpforms-field-required wpforms-input-temp-name\" data-rule-creditcard=\"yes\" autocomplete=\"off\" required><label for=\"wpforms-398-field_48\" class=\"wpforms-field-sublabel after\">Card Number<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-authorize_net-container\"><div class=\"wpforms-field-authorize_net-expiration\"><div class=\"wpforms-field-authorize_net-month\"><select id=\"wpforms-398-field_48-cardmonth\" class=\"wpforms-field-authorize_net-cardmonth wpforms-field-required wpforms-input-temp-name\" aria-label=\"Expiration month\" required><option class=\"placeholder\" selected disabled value=\"\">MM<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><option value=\"11\">11<\/option><option value=\"12\">12<\/option><\/select><label for=\"wpforms-398-field_48-cardmonth\" class=\"wpforms-field-sublabel after\">Expiration<\/label><\/div><span>\/<\/span><div class=\"wpforms-field-authorize_net-year\"><select id=\"wpforms-398-field_48-cardyear\" class=\"wpforms-field-authorize_net-cardyear wpforms-field-required wpforms-input-temp-name\" aria-label=\"Expiration year\" required><option class=\"placeholder\" selected disabled value=\"\">YY<\/option><option value=\"26\">26<\/option><option value=\"27\">27<\/option><option value=\"28\">28<\/option><option value=\"29\">29<\/option><option value=\"30\">30<\/option><option value=\"31\">31<\/option><option value=\"32\">32<\/option><option value=\"33\">33<\/option><option value=\"34\">34<\/option><option value=\"35\">35<\/option><option value=\"36\">36<\/option><\/select><\/div><\/div><div class=\"wpforms-field-authorize_net-code\"><input type=\"text\" id=\"wpforms-398-field_48-cardcvc\" class=\"wpforms-field-authorize_net-cardcvc wpforms-field-required wpforms-input-temp-name\" maxlength=\"4\" autocomplete=\"off\" required><label for=\"wpforms-398-field_48-cardcvc\" class=\"wpforms-field-sublabel after\">Security Code<\/label><\/div><\/div><\/div><\/div><div id=\"wpforms-398-field_68-container\" class=\"wpforms-field wpforms-field-payment-total wpforms-field-medium\" data-field-type=\"payment-total\" data-field-id=\"68\"><label class=\"wpforms-field-label\">Total<\/label><div class=\"wpforms-payment-total\" style=\"\">&#036;0.00<\/div><input type=\"hidden\" id=\"wpforms-398-field_68\" class=\"wpforms-field-medium wpforms-payment-total\" name=\"wpforms[fields][68]\" value=\"0\"><\/div><div id=\"wpforms-398-field_54-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"54\"><label class=\"wpforms-field-label\">Confirmation<\/label><ul id=\"wpforms-398-field_54\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-398-field_54_1\" name=\"wpforms[fields][54][]\" value=\"I agree to the above payment.\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-398-field_54_1\">I agree to the above payment.<\/label><\/li><\/ul><\/div><div id=\"wpforms-398-field_49-container\" class=\"wpforms-field wpforms-field-signature\" data-field-type=\"signature\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-398-field_49\">Signature <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-398-field_49\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][49]\" autocomplete=\"off\" inputmode=\"none\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\" data-input-method=\"draw\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-398-field_49-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) 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