jQuery36000075385657498647785_1664493514675({"html":"\r\n\u003cscript type=\"text/javascript\"\u003evar benstates=\u0027{\"United States\":{\"AL\":\"AL\",\"AK\":\"AK\",\"AZ\":\"AZ\",\"AR\":\"AR\",\"CA\":\"CA\",\"CO\":\"CO\",\"CT\":\"CT\",\"DE\":\"DE\",\"DC\":\"DC\",\"FL\":\"FL\",\"GA\":\"GA\",\"GU\":\"GU\",\"HI\":\"HI\",\"ID\":\"ID\",\"IL\":\"IL\",\"IN\":\"IN\",\"IA\":\"IA\",\"KS\":\"KS\",\"KY\":\"KY\",\"LA\":\"LA\",\"ME\":\"ME\",\"MD\":\"MD\",\"MA\":\"MA\",\"MI\":\"MI\",\"MN\":\"MN\",\"MS\":\"MS\",\"MO\":\"MO\",\"MT\":\"MT\",\"NE\":\"NE\",\"NV\":\"NV\",\"NH\":\"NH\",\"NJ\":\"NJ\",\"NM\":\"NM\",\"NY\":\"NY\",\"NC\":\"NC\",\"ND\":\"ND\",\"OH\":\"OH\",\"OK\":\"OK\",\"OR\":\"OR\",\"PA\":\"PA\",\"PR\":\"PR\",\"RI\":\"RI\",\"SC\":\"SC\",\"SD\":\"SD\",\"TN\":\"TN\",\"TX\":\"TX\",\"UT\":\"UT\",\"VT\":\"VT\",\"VA\":\"VA\",\"WA\":\"WA\",\"WV\":\"WV\",\"WI\":\"WI\",\"WY\":\"WY\"},\"Canada\":{\"AB\":\"Alberta\",\"BC\":\"British Columbia\",\"MB\":\"Manitoba\",\"NB\":\"New Brunswick\",\"NL\":\"Newfoundland and Labrador\",\"NT\":\"Northwest Territories\",\"NS\":\"Nova Scotia\",\"NU\":\"Nunavut\",\"ON\":\"Ontario\",\"PE\":\"Prince Edward Island\",\"QC\":\"Quebec\",\"SK\":\"Saskatchewan\",\"YT\":\"Yukon\"},\"United Kingdom\":{\"England\":\"England\",\"Wales\":\"Wales\",\"Scotland\":\"Scotland\",\"Northern Ireland\":\"Northern Ireland\"},\"Kosovo\":{\"Ferizaj\":\"Ferizaj\",\"Gjakova\":\"Gjakova\",\"Gjilan\":\"Gjilan\",\"Mitrovica\":\"Mitrovica\",\"Peja/Peć\":\"Peja/Peć\",\"Pristina\":\"Pristina\",\"Prizren\":\"Prizren\"},\"Mexico\":{\"Aguascalientes\":\"Aguascalientes\",\"Baja California\":\"Baja California\",\"Baja California Sur\":\"Baja California Sur\",\"Campeche\":\"Campeche\",\"Chiapas\":\"Chiapas\",\"Distrito Federal\":\"Distrito Federal\",\"Chihuahua\":\"Chihuahua\",\"Coahuila\":\"Coahuila\",\"Colima\":\"Colima\",\"Durango\":\"Durango\",\"Guanajuato\":\"Guanajuato\",\"Guerrero\":\"Guerrero\",\"Hidalgo\":\"Hidalgo\",\"Jalisco\":\"Jalisco\",\"México\":\"México\",\"Michoacán\":\"Michoacán\",\"Morelos\":\"Morelos\",\"Nayarit\":\"Nayarit\",\"Nuevo León\":\"Nuevo León\",\"Oaxaca\":\"Oaxaca\",\"Puebla\":\"Puebla\",\"Querétaro\":\"Querétaro\",\"Quintana Roo\":\"Quintana Roo\",\"San Luis Potosí\":\"San Luis Potosí\",\"Sinaloa\":\"Sinaloa\",\"Sonora\":\"Sonora\",\"Tabasco\":\"Tabasco\",\"Tamaulipas\":\"Tamaulipas\",\"Tlaxcala\":\"Tlaxcala\",\"Veracruz\":\"Veracruz\",\"Yucatán\":\"Yucatán\",\"Zacatecas\":\"Zacatecas\"},\"Brazil\":{\"Acre\":\"AC\",\"Alagoas\":\"AL\",\"Amapá\":\"AP\",\"Amazonas\":\"AM\",\"Bahia\":\"BA\",\"Ceará\":\"CE\",\"Distrito Federal\":\"DF\",\"Espírito Santo\":\"ES\",\"Goiás\":\"GO\",\"Maranhão\":\"MA\",\"Mato Grosso\":\"MT\",\"Mato Grosso do Sul\":\"MS\",\"Minas Gerais\":\"MG\",\"Pará\":\"PA\",\"Paraíba\":\"PB\",\"Paraná\":\"PR\",\"Pernambuco\":\"PE\",\"Piauí\":\"PI\",\"Rio de Janeiro\":\"RJ\",\"Rio Grande do Norte\":\"RN\",\"Rio Grande do Sul\":\"RS\",\"Rondônia\":\"RO\",\"Roraima\":\"RR\",\"Santa Catarina\":\"SC\",\"São Paulo\":\"SP\",\"Sergipe\":\"SE\",\"Tocantins\":\"TO\"},\"Philippines\":{\"Abra\":\"Abra\",\"Agusan del Norte\":\"Agusan del Norte\",\"Agusan del Sur\":\"Agusan del Sur\",\"Aklan\":\"Aklan\",\"Albay\":\"Albay\",\"Antique\":\"Antique\",\"Apayao\":\"Apayao\",\"Aurora\":\"Aurora\",\"Basilan\":\"Basilan\",\"Bataan\":\"Bataan\",\"Batanes\":\"Batanes\",\"Batangas\":\"Batangas\",\"Benguet\":\"Benguet\",\"Biliran\":\"Biliran\",\"Bohol\":\"Bohol\",\"Bukidnon\":\"Bukidnon\",\"Bulacan\":\"Bulacan\",\"Cagayan\":\"Cagayan\",\"Camarines Norte\":\"Camarines Norte\",\"Camarines Sur\":\"Camarines Sur\",\"Camiguin\":\"Camiguin\",\"Capiz\":\"Capiz\",\"Catanduanes\":\"Catanduanes\",\"Cavite\":\"Cavite\",\"Cebu\":\"Cebu\",\"Compostela Valley\":\"Compostela Valley\",\"Cotabato\":\"Cotabato\",\"Davao del Norte\":\"Davao del Norte\",\"Davao del Sur\":\"Davao del Sur\",\"Davao Occidental\":\"Davao Occidental\",\"Davao Oriental\":\"Davao Oriental\",\"Dinagat Islands\":\"Dinagat Islands\",\"Eastern Samar\":\"Eastern Samar\",\"Guimaras\":\"Guimaras\",\"Ifugao\":\"Ifugao\",\"Ilocos Norte\":\"Ilocos Norte\",\"Ilocos Sur\":\"Ilocos Sur\",\"Iloilo\":\"Iloilo\",\"Isabela\":\"Isabela\",\"Kalinga\":\"Kalinga\",\"La Union\":\"La Union\",\"Laguna\":\"Laguna\",\"Lanao del Norte\":\"Lanao del Norte\",\"Lanao del Sur\":\"Lanao del Sur\",\"Leyte\":\"Leyte\",\"Maguindanao\":\"Maguindanao\",\"Marinduque\":\"Marinduque\",\"Masbate\":\"Masbate\",\"Misamis Occidental\":\"Misamis Occidental\",\"Misamis Oriental\":\"Misamis Oriental\",\"Mountain Province\":\"Mountain Province\",\"Negros Occidental\":\"Negros Occidental\",\"Negros Oriental\":\"Negros Oriental\",\"Northern Samar\":\"Northern Samar\",\"Nueva Ecija\":\"Nueva Ecija\",\"Nueva Vizcaya\":\"Nueva Vizcaya\",\"Occidental Mindoro\":\"Occidental Mindoro\",\"Oriental Mindoro\":\"Oriental Mindoro\",\"Palawan\":\"Palawan\",\"Pampanga\":\"Pampanga\",\"Pangasinan\":\"Pangasinan\",\"Quezon\":\"Quezon\",\"Quirino\":\"Quirino\",\"Rizal\":\"Rizal\",\"Romblon\":\"Romblon\",\"Samar\":\"Samar\",\"Sarangani\":\"Sarangani\",\"Siquijor\":\"Siquijor\",\"Sorsogon\":\"Sorsogon\",\"South Cotabato\":\"South Cotabato\",\"Southern Leyte\":\"Southern Leyte\",\"Sultan Kudarat\":\"Sultan Kudarat\",\"Sulu\":\"Sulu\",\"Surigao del Norte\":\"Surigao del Norte\",\"Surigao del Sur\":\"Surigao del Sur\",\"Tarlac\":\"Tarlac\",\"Tawi-Tawi\":\"Tawi-Tawi\",\"Zambales\":\"Zambales\",\"Zamboanga del Norte\":\"Zamboanga del Norte\",\"Zamboanga del Sur\":\"Zamboanga del Sur\",\"Zamboanga\":\"Zamboanga\",\"Sibugay\":\"Sibugay\",\"Metro Manila\":\"Metro Manila\"},\"Australia\":{\"New South Wales\":\"New South Wales\",\"Queensland\":\"Queensland\",\"South Australia\":\"South Australia\",\"Tasmania\":\"Tasmania\",\"Victoria\":\"Victoria\",\"Western Australia\":\"Western Australia\"},\"Spain\":{\"A Coruña\":\"A Coruña\",\"Álava\":\"Álava\",\"Albacete\":\"Albacete\",\"Alicante\":\"Alicante\",\"Almería\":\"Almería\",\"Asturias\":\"Asturias\",\"Ávila\":\"Ávila\",\"Badajoz\":\"Badajoz\",\"Balearic Islands\":\"Balearic Islands\",\"Barcelona\":\"Barcelona\",\"Biscay\":\"Biscay\",\"Burgos\":\"Burgos\",\"Cáceres \":\"Cáceres \",\"Cádiz\":\"Cádiz\",\"Cantabria\":\"Cantabria\",\"Castelló (Valencian) \":\"Castelló (Valencian) \",\"Ciudad Real\":\"Ciudad Real\",\"Córdoba\":\"Córdoba\",\"Cuenca\":\"Cuenca\",\"Guipúzcoa \":\"Guipúzcoa \",\"Gerona\":\"Gerona\",\"Granada\":\"Granada\",\"Guadalajara\":\"Guadalajara\",\"Huelva\":\"Huelva\",\"Huesca\":\"Huesca\",\"Jaén\":\"Jaén\",\"La Rioja\":\"La Rioja\",\"Las Palmas\":\"Las Palmas\",\"León\":\"León\",\"Lleida\":\"Lleida\",\"Lugo \":\"Lugo \",\"Madrid \":\"Madrid \",\"Málaga \":\"Málaga \",\"Murcia \":\"Murcia \",\"Navarra\":\"Navarra\",\"Orense\":\"Orense\",\"Palencia \":\"Palencia \",\"Pontevedra \":\"Pontevedra \",\"Salamanca \":\"Salamanca \",\"Santa Cruz\":\"Santa Cruz\",\"Segovia \":\"Segovia \",\"Sevilla\":\"Sevilla\",\"Soria\":\"Soria\",\"Tarragona\":\"Tarragona\",\"Teruel\":\"Teruel\",\"Toledo\":\"Toledo\",\"Valencian\":\"Valencian\",\"Valladolid\":\"Valladolid\",\"Zamora \":\"Zamora \",\"Zaragoza\":\"Zaragoza\"},\"Portugal\":{\"Lisbon\":\"Lisbon\",\"Leiria\":\"Leiria\",\"Santarém\":\"Santarém\",\"Setúbal\":\"Setúbal\",\"Beja\":\"Beja\",\"Faro\":\"Faro\",\"Évora\":\"Évora\",\"Portalegre\":\"Portalegre\",\"Castelo Branco\":\"Castelo Branco\",\"Guarda\":\"Guarda\",\"Coimbra\":\"Coimbra\",\"Aveiro\":\"Aveiro\",\"Viseu\":\"Viseu\",\"Bragança\":\"Bragança\",\"Vila Real\":\"Vila Real\",\"Porto\":\"Porto\",\"Braga\":\"Braga\",\"Viana do Castelo\":\"Viana do Castelo\"},\"France\":{\"Paris\":\"Paris\",\"Bourges\":\"Bourges\",\"Orléans\":\"Orléans\",\"Normandy\":\"Normandy\",\"Languedoc\":\"Languedoc\",\"Lyon\":\"Lyon\",\"Grenoble\":\"Grenoble\",\"Troyes\":\"Troyes\",\"La Rochelle\":\"La Rochelle\",\"Saintes\":\"Saintes\",\"Poitiers\":\"Poitiers\",\"Bordeaux\":\"Bordeaux\",\"Dijon\":\"Dijon\",\"Amiens\":\"Amiens\",\"Angers\":\"Angers\",\"Aix-en-Provence\":\"Aix-en-Provence\",\"Angoulême\":\"Angoulême\",\"Moulins\":\"Moulins\",\"Marche\":\"Marche\",\"Brittany\":\"Brittany\",\"Le Mans\":\"Le Mans\",\"Tours\":\"Tours\",\"Limoges\":\"Limoges\",\"Foix\":\"Foix\",\"Auvergne\":\"Auvergne\",\"Béarn\":\"Béarn\",\"Alsace\":\"Alsace\",\"Artois\":\"Artois\",\"Roussillon\":\"Roussillon\",\"Lille\":\"Lille\",\"Besançon\":\"Besançon\",\"Verdun\":\"Verdun\",\"Corsica\":\"Corsica\",\"Nevers\":\"Nevers\"},\"Italy\":{\"Agrigento\":\"Agrigento\",\"Alessandria\":\"Alessandria\",\"Ancona\":\"Ancona\",\"Aosta\":\"Aosta\",\"Arezzo\":\"Arezzo\",\"Ascoli Piceno\":\"Ascoli Piceno\",\"Asti\":\"Asti\",\"Avellino\":\"Avellino\",\"Bari\":\"Bari\",\"Barletta-Andria-Trani\":\"Barletta-Andria-Trani\",\"Belluno\":\"Belluno\",\"Benevento\":\"Benevento\",\"Bergamo\":\"Bergamo\",\"Biella\":\"Biella\",\"Bologna\":\"Bologna\",\"Brescia\":\"Brescia\",\"Brindisi\":\"Brindisi\",\"Cagliari\":\"Cagliari\",\"Caltanissetta\":\"Caltanissetta\",\"Campobasso\":\"Campobasso\",\"Caserta\":\"Caserta\",\"Catania\":\"Catania\",\"Catanzaro\":\"Catanzaro\",\"Chieti\":\"Chieti\",\"Como\":\"Como\",\"Cosenza\":\"Cosenza\",\"Cremona\":\"Cremona\",\"Crotone\":\"Crotone\",\"Cuneo\":\"Cuneo\",\"Enna\":\"Enna\",\"Fermo\":\"Fermo\",\"Ferrara\":\"Ferrara\",\"Florence\":\"Florence\",\"Foggia\":\"Foggia\",\"Forlì-Cesena\":\"Forlì-Cesena\",\"Frosinone\":\"Frosinone\",\"Genoa\":\"Genoa\",\"Gorizia\":\"Gorizia\",\"Grosseto\":\"Grosseto\",\"Imperia\":\"Imperia\",\"Isernia\":\"Isernia\",\"La Spezia\":\"La Spezia\",\"L\\u0027Aquila\":\"L\\u0027Aquila\",\"Latina\":\"Latina\",\"Lecce\":\"Lecce\",\"Lecco\":\"Lecco\",\"Livorno\":\"Livorno\",\"Lodi\":\"Lodi\",\"Lucca\":\"Lucca\",\"Macerata\":\"Macerata\",\"Mantua\":\"Mantua\",\"Massa and Carrara\":\"Massa and Carrara\",\"Matera\":\"Matera\",\"Messina\":\"Messina\",\"Milan\":\"Milan\",\"Modena\":\"Modena\",\"Monza and Brianza\":\"Monza and Brianza\",\"Naples\":\"Naples\",\"Novara\":\"Novara\",\"Nuoro\":\"Nuoro\",\"Oristano\":\"Oristano\",\"Padua\":\"Padua\",\"Palermo\":\"Palermo\",\"Parma\":\"Parma\",\"Pavia\":\"Pavia\",\"Perugia\":\"Perugia\",\"Pesaro and Urbino\":\"Pesaro and Urbino\",\"Pescara\":\"Pescara\",\"Piacenza\":\"Piacenza\",\"Pisa\":\"Pisa\",\"Pistoia\":\"Pistoia\",\"Pordenone\":\"Pordenone\",\"Potenza\":\"Potenza\",\"Prato\":\"Prato\",\"Ragusa\":\"Ragusa\",\"Ravenna\":\"Ravenna\",\"Reggio Calabria\":\"Reggio Calabria\",\"Reggio Emilia\":\"Reggio Emilia\",\"Rieti\":\"Rieti\",\"Rimini\":\"Rimini\",\"Rome\":\"Rome\",\"Rovigo\":\"Rovigo\",\"Salerno\":\"Salerno\",\"Sassari\":\"Sassari\",\"Savona\":\"Savona\",\"Siena\":\"Siena\",\"Sondrio\":\"Sondrio\",\"South Sardinia\":\"South Sardinia\",\"South Tyrol\":\"South Tyrol\",\"Syracuse\":\"Syracuse\",\"Taranto\":\"Taranto\",\"Teramo\":\"Teramo\",\"Terni\":\"Terni\",\"Trapani\":\"Trapani\",\"Trento\":\"Trento\",\"Treviso\":\"Treviso\",\"Trieste\":\"Trieste\",\"Turin\":\"Turin\",\"Udine\":\"Udine\",\"Varese\":\"Varese\",\"Venice\":\"Venice\",\"Verbano-Cusio-Ossola\":\"Verbano-Cusio-Ossola\",\"Vercelli\":\"Vercelli\",\"Verona\":\"Verona\",\"Vibo Valentia\":\"Vibo Valentia\",\"Vicenza\":\"Vicenza\",\"Viterbo\":\"Viterbo\"},\"Germany\":{\"Baden-Württemberg\":\"Baden-Württemberg\",\"Bavaria\":\"Bavaria\",\"Berlin\":\"Berlin\",\"Brandenburg\":\"Brandenburg\",\"Bremen\":\"Bremen\",\"Hamburg\":\"Hamburg\",\"Hesse\":\"Hesse\",\"Lower Saxony\":\"Lower Saxony\",\"Mecklenburg-Western Pomerania\":\"Mecklenburg-Western Pomerania\",\"North Rhine-Westphalia\":\"North Rhine-Westphalia\",\"Rhineland-Palatinate\":\"Rhineland-Palatinate\",\"Saarland\":\"Saarland\",\"Saxony\":\"Saxony\",\"Saxony-Anhalt\":\"Saxony-Anhalt\",\"Schleswig-Holstein\":\"Schleswig-Holstein\",\"Thuringia\":\"Thuringia\"},\"Ireland\":{\"Connacht\":\"Connacht\",\"Leinster\":\"Leinster\",\"Munster\":\"Munster\",\"Ulster\":\"Ulster\"}}\u0027;benProcessorFee = 3;\u003c/script\u003e\r\n\u003cform id=\u0027benforminput\u0027 class=\u0027benforminput\u0027 method=\u0027post\u0027 enctype=\u0027multipart/form-data\u0027 action=\u0027https://secure.engageddonor.com/form.ashx?id=51\u0026url=https%3a%2f%2faidsunited.org%2frelief-recovery-resilience-fund%2f\u0026c=3C6C4007-DD79-4FA2-9029-CE596895092D\u0027\u003e\u003cdiv id=\"concntrl101\" class=\"benformelement benformcon\"\u003e\r\n\u003cdiv class=\"bentableheading\"\u003ePersonal Information\u003c/div\u003e\r\n\r\n\u003cdiv class=\"bentable form benmobile\"\u003e\r\n \u003cdiv id=\"concntrl101_ctl00_benrow\"\u003e\r\n \u003cdiv\u003e\r\n \u003cspan id=\"concntrl101_ctl00_lbl\" class=\"ben_name\"\u003eFirst Name\u003c/span\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \r\n \u003cinput name=\"concntrl101$ctl00$txt\" type=\"text\" id=\"concntrl101_ctl00_txt\" bFirstName=\"\" onchange=\"benPrepopHonorRollName();\" class=\"ben_name\" autocomplete=\"given-name\" Required=\"\" /\u003e\r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n\r\n\u003cdiv id=\"concntrl101_ctl01_benrow\"\u003e\r\n \u003cdiv\u003e\r\n \u003cspan id=\"concntrl101_ctl01_lbl\" class=\"ben_name\"\u003eLast Name\u003c/span\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \r\n \u003cinput name=\"concntrl101$ctl01$txt\" type=\"text\" id=\"concntrl101_ctl01_txt\" bLastName=\"\" onchange=\"benPrepopHonorRollName();\" class=\"ben_name\" autocomplete=\"family-name\" Required=\"\" /\u003e\r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n\r\n\u003cdiv id=\"concntrl101_ctl02_benrow\"\u003e\r\n \u003cdiv\u003e\r\n \u003cspan id=\"concntrl101_ctl02_lbl\"\u003eEmail\u003c/span\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \r\n \u003cinput name=\"concntrl101$ctl02$txt\" type=\"text\" id=\"concntrl101_ctl02_txt\" class=\"ben_email\" autocomplete=\"email\" Required=\"\" /\u003e\r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n\r\n\u003cdiv id=\"ctl03_benrow\"\u003e\r\n \u003cdiv\u003e\r\n \u003cspan id=\"ctl03_lbl\"\u003ePhone\u003c/span\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \r\n \u003cinput name=\"concntrl101$ctl03$txt\" type=\"text\" id=\"ctl03_txt\" autocomplete=\"tel\" Required=\"\" /\u003e\r\n \r\n \r\n \r\n \r\n \r\n \r\n \u003cscript type=\"text/javascript\"\u003ejB(\u0027#ctl03_txt\u0027).mask(\u0027(999) 999-9999? x99999\u0027);\u003c/script\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n\r\n\u003cdiv id=\"concntrl101_ctl04_benrow\"\u003e\r\n \u003cdiv\u003e\r\n \u003cspan id=\"concntrl101_ctl04_lbl\"\u003eAddress Line 1\u003c/span\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \r\n \u003cinput name=\"concntrl101$ctl04$txt\" type=\"text\" id=\"concntrl101_ctl04_txt\" autocomplete=\"address-line1\" Required=\"\" /\u003e\r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n\r\n\u003cdiv id=\"concntrl101_ctl05_benrow\"\u003e\r\n \u003cdiv\u003e\r\n \u003cspan id=\"concntrl101_ctl05_lbl\"\u003eCity\u003c/span\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \r\n \u003cinput name=\"concntrl101$ctl05$txt\" type=\"text\" id=\"concntrl101_ctl05_txt\" Required=\"\" /\u003e\r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n\r\n\u003cdiv id=\"concntrl101_ctl06_benrow\"\u003e\r\n \u003cdiv\u003e\r\n \u003cspan id=\"concntrl101_ctl06_lbl\"\u003eProvince/State\u003c/span\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \r\n \r\n \r\n \r\n \r\n \u003cselect name=\"concntrl101$ctl06$ddlState\" id=\"concntrl101_ctl06_ddlState\" class=\"dropdown ben_state\" rftid=\"1\" Required=\"\"\u003e\r\n\r\n\u003c/select\u003e\r\n \r\n \r\n \u003cscript type=\"text/javascript\"\u003ebenLoadStates(\u00271\u0027);\u003c/script\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n\r\n\u003cdiv id=\"concntrl101_ctl07_benrow\"\u003e\r\n \u003cdiv\u003e\r\n \u003cspan id=\"concntrl101_ctl07_lbl\"\u003ePostal Code\u003c/span\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \r\n \u003cinput name=\"concntrl101$ctl07$txt\" type=\"text\" id=\"concntrl101_ctl07_txt\" autocomplete=\"postal-code\" Required=\"\" /\u003e\r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n\r\n\r\n\u003c/div\u003e\r\n\u003c/div\u003e\u003cdiv id=\"doncntrl102\" class=\"benformelement benformdon\"\u003e\r\n\u003cdiv style=\"margin: 10px 0px;\"\u003e\r\n \u003cscript type=\"text/javascript\"\u003e\r\n \r\n \u003c/script\u003e\r\n \u003cdiv class=\"heading3\" style=\"display: none;\"\u003e\r\n Relief, Recover, and Resilience Fund\r\n \u003c/div\u003e\r\n \u003cdiv class=\"bentableheading\"\u003e\r\n Donation\u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003ctable id=\"rblLevels\" class=\"bendonlevels\" style=\"font-size:13px;font-weight:bold;\"\u003e\r\n\t\u003ctr\u003e\r\n\t\t\u003ctd\u003e\u003cinput id=\"rblLevels_0\" type=\"radio\" name=\"doncntrl102$rblLevels\" value=\"500\" onclick=\"jB(\u0026#39;#ben_DonationAmount\u0026#39;).val(jB(this).val());updatePaymentTotalsNew(this);\" /\u003e\u003clabel for=\"rblLevels_0\"\u003e$500\u003c/label\u003e\u003c/td\u003e\u003ctd\u003e\u003cinput id=\"rblLevels_1\" type=\"radio\" name=\"doncntrl102$rblLevels\" value=\"100\" onclick=\"jB(\u0026#39;#ben_DonationAmount\u0026#39;).val(jB(this).val());updatePaymentTotalsNew(this);\" /\u003e\u003clabel for=\"rblLevels_1\"\u003e$100\u003c/label\u003e\u003c/td\u003e\u003ctd\u003e\u003cinput id=\"rblLevels_2\" type=\"radio\" name=\"doncntrl102$rblLevels\" value=\"75\" onclick=\"jB(\u0026#39;#ben_DonationAmount\u0026#39;).val(jB(this).val());updatePaymentTotalsNew(this);\" /\u003e\u003clabel for=\"rblLevels_2\"\u003e$75\u003c/label\u003e\u003c/td\u003e\u003ctd\u003e\u003cinput id=\"rblLevels_3\" type=\"radio\" name=\"doncntrl102$rblLevels\" value=\"50\" onclick=\"jB(\u0026#39;#ben_DonationAmount\u0026#39;).val(jB(this).val());updatePaymentTotalsNew(this);\" /\u003e\u003clabel for=\"rblLevels_3\"\u003e$50\u003c/label\u003e\u003c/td\u003e\u003ctd\u003e\u003cinput id=\"rblLevels_4\" type=\"radio\" name=\"doncntrl102$rblLevels\" value=\"25\" onclick=\"jB(\u0026#39;#ben_DonationAmount\u0026#39;).val(jB(this).val());updatePaymentTotalsNew(this);\" /\u003e\u003clabel for=\"rblLevels_4\"\u003e$25\u003c/label\u003e\u003c/td\u003e\u003ctd\u003e\u003cinput id=\"rblLevels_5\" type=\"radio\" name=\"doncntrl102$rblLevels\" value=\"0\" /\u003e\u003clabel for=\"rblLevels_5\"\u003eOther\u003c/label\u003e\u003c/td\u003e\r\n\t\u003c/tr\u003e\r\n\u003c/table\u003e\r\n \u003c/div\u003e\r\n \u003cdiv class=\"bentable form benmobile\"\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003eDonation Amount:\u003c/div\u003e\r\n \u003cdiv style=\"position: relative;\"\u003e\r\n \u003cdiv style=\"position: absolute; left: -5px; top: 2px; display: none;\"\u003e$\u003c/div\u003e\r\n \u003cinput name=\"doncntrl102$ben_DonationAmount\" type=\"text\" autocomplete=\"off\" id=\"ben_DonationAmount\" class=\"benformdonationamount\" minimum=\"0\" onchange=\"updatePaymentTotalsNew(this); jB(\u0026#39;#rblLevels input[type=radio]\u0026#39;).prop(\u0026#39;checked\u0026#39;, \u0026#39;\u0026#39;); jB(\u0026#39;#rblLevels input[value=0]\u0026#39;).prop(\u0026#39;checked\u0026#39;, true);\" onkeyup=\"updatePaymentTotalsNew(this); jB(\u0026#39;#rblLevels input[type=radio]\u0026#39;).prop(\u0026#39;checked\u0026#39;, \u0026#39;\u0026#39;); jB(\u0026#39;#rblLevels input[value=0]\u0026#39;).prop(\u0026#39;checked\u0026#39;, true);\" /\u003e\r\n \u003cinput type=\"hidden\" name=\"doncntrl102$ben_hdfDonationOverride\" id=\"doncntrl102_ben_hdfDonationOverride\" /\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \r\n \u003c/div\u003e\r\n \r\n \r\n \u003cdiv class=\"benrecurring\"\u003e\r\n \u003cdiv style=\"margin-top: 8px;\"\u003e\r\n \u003cinput name=\"doncntrl102$cbxRecurring\" type=\"checkbox\" id=\"doncntrl102_cbxRecurring\" onchange=\"var r=\u0026#39;none\u0026#39;; if (jQuery(this).prop(\u0026#39;checked\u0026#39;)){r=\u0026#39;\u0026#39;;} jQuery(\u0026#39;#recurringdiv\u0026#39;).css(\u0026#39;display\u0026#39;,r); updatePaymentTotalsNew(this);\" /\u003e\r\n \u003clabel for=\"doncntrl102_cbxRecurring\" style=\"font-size: 18px;\"\u003eMake this a recurring gift\u003c/label\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003eYour gift will automatically repeat until you decide to cancel it.\u003c/div\u003e\r\n \u003cdiv id=\"recurringdiv\" class=\"table form\" style=\"display: none; margin-top: 4px;\"\u003e\r\n \u003ctable id=\"doncntrl102_rblRecurring\" onchange=\"updatePaymentTotalsNew(this);\"\u003e\r\n\t\u003ctr\u003e\r\n\t\t\u003ctd\u003e\u003cinput id=\"doncntrl102_rblRecurring_0\" type=\"radio\" name=\"doncntrl102$rblRecurring\" value=\"Weekly\" /\u003e\u003clabel for=\"doncntrl102_rblRecurring_0\"\u003eWeekly\u003c/label\u003e\u003c/td\u003e\u003ctd\u003e\u003cinput id=\"doncntrl102_rblRecurring_1\" type=\"radio\" name=\"doncntrl102$rblRecurring\" value=\"Monthly\" /\u003e\u003clabel for=\"doncntrl102_rblRecurring_1\"\u003eMonthly\u003c/label\u003e\u003c/td\u003e\u003ctd\u003e\u003cinput id=\"doncntrl102_rblRecurring_2\" type=\"radio\" name=\"doncntrl102$rblRecurring\" value=\"Quarterly\" /\u003e\u003clabel for=\"doncntrl102_rblRecurring_2\"\u003eQuarterly\u003c/label\u003e\u003c/td\u003e\u003ctd\u003e\u003cinput id=\"doncntrl102_rblRecurring_3\" type=\"radio\" name=\"doncntrl102$rblRecurring\" value=\"Annually\" /\u003e\u003clabel for=\"doncntrl102_rblRecurring_3\"\u003eAnnually\u003c/label\u003e\u003c/td\u003e\r\n\t\u003c/tr\u003e\r\n\u003c/table\u003e\r\n \r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \r\n \u003cdiv class=\"bentable form benmobile\"\u003e\r\n \r\n\r\n\u003cdiv id=\"doncntrl102_56\" class=\"benfield \"\u003e\r\n \u003cdiv\u003e\r\n \u003cspan id=\"doncntrl102_56_lbl\"\u003eYes, this is an honor or memorial gift\u003c/span\u003e\r\n \u003cspan id=\"doncntrl102_56_rfcfee\" class=\"rfcfee\"\u003e\u003c/span\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \r\n \u003cselect name=\"doncntrl102$56$ddl\" id=\"doncntrl102_56_ddl\" ShowQuantity=\"0\" autocomplete=\"new-text\" FieldID=\"56\" MaxQuantity=\"0\" Fee=\"0\" DefaultValue=\"\" onchange=\"updateConditionsNew(this);\" FieldType=\"6\" rdfid=\"0\"\u003e\r\n\t\u003coption value=\"\"\u003e\u003c/option\u003e\r\n\t\u003coption value=\"true\"\u003eYes\u003c/option\u003e\r\n\t\u003coption value=\"false\"\u003eNo\u003c/option\u003e\r\n\r\n\u003c/select\u003e\r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cspan class=\"benfieldquantitylabel\" style=\"display: none;\"\u003eQuantity: \u003c/span\u003e\r\n \u003cselect name=\"doncntrl102$56$ddlQuantity\" id=\"doncntrl102_56_ddlQuantity\" class=\"benfieldquantity\" onchange=\"updateConditionsNew(this);\" style=\"display: none;\"\u003e\r\n\r\n\u003c/select\u003e\r\n \u003c/div\u003e\r\n\u003c/div\u003e\r\n\r\n\r\n\u003cdiv id=\"doncntrl102_46\" class=\"benfield \" style=\"display:none;\"\u003e\r\n \u003cdiv\u003e\r\n \u003cspan id=\"doncntrl102_46_lbl\"\u003eI wish to cover the credit card processing fee\u003c/span\u003e\r\n \u003cspan id=\"doncntrl102_46_rfcfee\" class=\"rfcfee\"\u003e\u003c/span\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \r\n \r\n \r\n \r\n \r\n \u003cinput name=\"doncntrl102$46$46_cbxprocessingfee\" type=\"checkbox\" id=\"doncntrl102_46_46_cbxprocessingfee\" FieldType=\"9\" DefaultValue=\"\" FieldID=\"46\" MaxQuantity=\"0\" Fee=\"0\" ShowQuantity=\"0\" onchange=\"updateConditionsNew(this);\" rdfid=\"0\" checked=\"checked\" /\u003e\r\n \r\n \r\n \r\n \r\n \r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cspan class=\"benfieldquantitylabel\" style=\"display: none;\"\u003eQuantity: \u003c/span\u003e\r\n \u003cselect name=\"doncntrl102$46$ddlQuantity\" id=\"doncntrl102_46_ddlQuantity\" class=\"benfieldquantity\" onchange=\"updateConditionsNew(this);\" style=\"display: none;\"\u003e\r\n\r\n\u003c/select\u003e\r\n \u003c/div\u003e\r\n\u003c/div\u003e\r\n\r\n\r\n\u003cdiv id=\"doncntrl102_58\" class=\"benfield \"\u003e\r\n \u003cdiv\u003e\r\n \u003cspan id=\"doncntrl102_58_lbl\"\u003eGift Type\u003c/span\u003e\r\n \u003cspan id=\"doncntrl102_58_rfcfee\" class=\"rfcfee\"\u003e\u003c/span\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \r\n \u003cselect name=\"doncntrl102$58$ddl\" id=\"doncntrl102_58_ddl\" ShowQuantity=\"0\" autocomplete=\"new-text\" FieldID=\"58\" MaxQuantity=\"0\" Fee=\"0\" DefaultValue=\"\" onchange=\"updateConditionsNew(this);\" FieldType=\"5\" rdfid=\"0\"\u003e\r\n\t\u003coption value=\"\"\u003e\u003c/option\u003e\r\n\t\u003coption value=\"29\"\u003eIn Honor of\u003c/option\u003e\r\n\t\u003coption value=\"30\"\u003eIn Memory of\u003c/option\u003e\r\n\r\n\u003c/select\u003e\r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cspan class=\"benfieldquantitylabel\" style=\"display: none;\"\u003eQuantity: \u003c/span\u003e\r\n \u003cselect name=\"doncntrl102$58$ddlQuantity\" id=\"doncntrl102_58_ddlQuantity\" class=\"benfieldquantity\" onchange=\"updateConditionsNew(this);\" style=\"display: none;\"\u003e\r\n\r\n\u003c/select\u003e\r\n \u003c/div\u003e\r\n\u003c/div\u003e\r\n\r\n\r\n\u003cdiv id=\"doncntrl102_66\" class=\"benfield \"\u003e\r\n \u003cdiv\u003e\r\n \u003cspan id=\"doncntrl102_66_lbl\"\u003eDonor Name On Acknowledgement Letter\u003c/span\u003e\r\n \u003cspan id=\"doncntrl102_66_rfcfee\" class=\"rfcfee\"\u003e\u003c/span\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cinput name=\"doncntrl102$66$txt\" type=\"text\" id=\"doncntrl102_66_txt\" ShowQuantity=\"0\" onkeyup=\"updateConditionsNew(this);\" FieldID=\"66\" MaxQuantity=\"0\" Fee=\"0\" DefaultValue=\"\" onchange=\"updateConditionsNew(this);\" FieldType=\"1\" rdfid=\"0\" autocomplete=\"new-text\" /\u003e\r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cspan class=\"benfieldquantitylabel\" style=\"display: none;\"\u003eQuantity: \u003c/span\u003e\r\n \u003cselect name=\"doncntrl102$66$ddlQuantity\" id=\"doncntrl102_66_ddlQuantity\" class=\"benfieldquantity\" onchange=\"updateConditionsNew(this);\" style=\"display: none;\"\u003e\r\n\r\n\u003c/select\u003e\r\n \u003c/div\u003e\r\n\u003c/div\u003e\r\n\r\n \u003c/div\u003e\r\n \r\n\r\n \r\n\u003c/div\u003e\r\n\u003c/div\u003e\u003cdiv id=\"paymentcntrl_benformpayment\" class=\"benformpayment\" style=\"margin: 10px 0px; display: none;\"\u003e\r\n \u003cdiv class=\"bentableheading\"\u003ePayment Information\u003c/div\u003e\r\n \u003cdiv id=\"benpaymentcreditcard\"\u003e\r\n \r\n \r\n \r\n \r\n \u003cstyle type=\"text/css\"\u003e\r\n .bluesnappaymentoption {\r\n text-align: center;\r\n }\r\n .bspayoptionitem {\r\n padding: 5px 10px;\r\n margin: 8px;\r\n border: 2px #999 solid;\r\n border-radius: 10px;\r\n cursor: pointer;\r\n background-color: #e2e2e2;\r\n min-width: 86px;\r\n }\r\n .bluesnappaymentoption .far {\r\n font-size: 60px;\r\n color: #777;\r\n font-weight: bold;\r\n }\r\n .bspayoptionitem:hover .far, .bspayoptionitem:hover span {\r\n color: #444;\r\n }\r\n .bspayoptionitem.active .far, .bspayoptionitem.active span {\r\n color: #222;\r\n }\r\n .bspayoptionitem.active {\r\n background-color: white;\r\n }\r\n .bluesnappaymentoption span {\r\n display: block;\r\n font-weight: bold;\r\n font-size: 12px;\r\n color: #777;\r\n }\r\n .benbsachwrap input[type=checkbox] {\r\n margin: 8px;\r\n }\r\n \u003c/style\u003e\r\n \r\n \u003cdiv id=\"benbsccwrap\"\u003e\r\n \u003cdiv class=\"benbspaymentswrap\"\u003e\r\n \u003cdiv class=\"bentable\"\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv data-bluesnap=\"ccn\"\u003e\u003c/div\u003e\r\n \u003cdiv style=\"width: 10px;\"\u003e\u003c/div\u003e\r\n \u003cdiv data-bluesnap=\"exp\" style=\"width: 25%;\"\u003e\u003c/div\u003e\r\n \u003cdiv style=\"width: 10px;\"\u003e\u003c/div\u003e\r\n \u003cdiv data-bluesnap=\"cvv\" style=\"width: 25%;\"\u003e\u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv data-bluesnap=\"walletButton\" style=\"height: auto; margin-top: 10px;\"\u003e\u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv class=\"benbspaymentsuccess table\" style=\"display: none;\"\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003e\u003ci class=\"fa fa-check-square\" style=\"margin: 20px 0px; color: green; font-size: 40px;\"\u003e\u003c/i\u003e\u003c/div\u003e\r\n \u003cdiv style=\"vertical-align: middle; font-size: 20px; padding-left: 14px;\"\u003eYour payment method has been selected\u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv id=\"benbsachwrap\" class=\"benbsachwrap\" style=\"display: none; border: solid 2px gray; border-radius: 10px; padding: 10px;\"\u003e\r\n \u003cdiv class=\"bentable form\"\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003e\r\n Account Holder\u0027s First Name\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cinput name=\"paymentcntrl$txtBSACHFirstName\" type=\"text\" id=\"paymentcntrl_txtBSACHFirstName\" placeholder=\"First Name\" /\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003e\r\n Account Holder\u0027s Last Name\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cinput name=\"paymentcntrl$txtBSACHLastName\" type=\"text\" id=\"paymentcntrl_txtBSACHLastName\" placeholder=\"Last Name\" /\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003e\r\n Routing Number\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cinput id=\"ecpRoutingNumber\" type=\"text\" name=\"ecpRoutingNumber\" data-bluesnap=\"ecpRoutingNumber\" placeholder=\"Routing Number\" autocompletetype=\"new-text\" /\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003e\r\n Account Number\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cinput id=\"ecpAccountNumber\" type=\"text\" name=\"ecpAccountNumber\" data-bluesnap=\"ecpAccountNumber\" placeholder=\"Account Number\" autocompletetype=\"new-text\" /\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003e\r\n Account Type\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cselect name=\"paymentcntrl$ecpAccountTypeSelect\" id=\"paymentcntrl_ecpAccountTypeSelect\" onchange=\"jB(\u0026#39;#ecpAccountType\u0026#39;).val(jB(this).val());\"\u003e\r\n\t\u003coption value=\"CONSUMER_CHECKING\"\u003ePersonal Checking\u003c/option\u003e\r\n\t\u003coption value=\"CONSUMER_SAVINGS\"\u003ePersonal Savings\u003c/option\u003e\r\n\t\u003coption value=\"CORPORATE_CHECKING\"\u003eCorporate Checking\u003c/option\u003e\r\n\t\u003coption value=\"CORPORATE_SAVINGS\"\u003eCorporate Savings\u003c/option\u003e\r\n\u003c/select\u003e\r\n \u003cinput id=\"ecpAccountType\" type=\"text\" name=\"ecpAccountType\" data-bluesnap=\"ecpAccountType\" placeholder=\"Account Type\" value=\"CONSUMER_CHECKING\" style=\"display: none; visibility: hidden;\" /\u003e \r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv style=\"padding: 8px;\"\u003e\r\n \u003cspan style=\"font-weight:bold;\"\u003e\u003cinput id=\"paymentcntrl_cbxBSACHAuthorize\" type=\"checkbox\" name=\"paymentcntrl$cbxBSACHAuthorize\" /\u003e\u003clabel for=\"paymentcntrl_cbxBSACHAuthorize\"\u003eI authorize this Electronic Check (ACH/ECP) transaction and agree to this debit of my account.\u003c/label\u003e\u003c/span\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cinput type=\"hidden\" name=\"paymentcntrl$hdfBlueSnapToken\" id=\"paymentcntrl_hdfBlueSnapToken\" /\u003e\u003cinput type=\"hidden\" name=\"paymentcntrl$hdfbenMobilePay\" id=\"paymentcntrl_hdfbenMobilePay\" /\u003e\u003cinput type=\"hidden\" name=\"paymentcntrl$hdfbenBSPaymentType\" id=\"paymentcntrl_hdfbenBSPaymentType\" /\u003e\u003cinput type=\"hidden\" name=\"paymentcntrl$hdfbenBSACHRouting\" id=\"paymentcntrl_hdfbenBSACHRouting\" /\u003e\u003cinput type=\"hidden\" name=\"paymentcntrl$hdfbenBSACHAccount\" id=\"paymentcntrl_hdfbenBSACHAccount\" /\u003e\u003cscript type=\"text/javascript\"\u003ebenLoadBlueSnapPayment(\u0027benforminput\u0027, \u0027eyJhbGciOiJIUzI1NiJ9.eyJwYXlsb2FkIjp7ImNvbW1vbkp3dFBheWxvYWQiOnsiaWQiOiI1MTI5MjcxOTc4NzAzMzYwNzA3ODI3NCIsImRhdGVDcmVhdGVkIjoxNzE2MDc2ODA2NzE3fSwibWVyY2hhbnRJZCI6MTI5NTk0MCwic2VudHJ5Ijp7Im1lcmNoYW50IjpmYWxzZSwiYXBwcyI6W119fX0.YJ1pigwwru2lGzyoj_3zaGFLsBeIwFMqJ5lw0FCfkK8._1\u0027);\u003c/script\u003e\r\n \u003cdiv style=\"margin: 8px 0px;\"\u003e\r\n \u003cinput id=\"paymentcntrl_cbxSavePaymentMethod\" type=\"checkbox\" name=\"paymentcntrl$cbxSavePaymentMethod\" /\u003e\u003clabel for=\"paymentcntrl_cbxSavePaymentMethod\"\u003eSecurely store my credit card information for future use\u003c/label\u003e\r\n \u003c/div\u003e\r\n \u003cdiv class=\"bentableheading\" style=\"display: none;\"\u003eBilling Information\u003c/div\u003e\r\n \u003cdiv class=\"\" style=\"display: none;\"\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003eAddress Line 1:\u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cinput name=\"paymentcntrl$ben_billingaddressline1\" type=\"text\" id=\"paymentcntrl_ben_billingaddressline1\" class=\"textbox\" /\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003eCity:\u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cinput name=\"paymentcntrl$ben_billingcity\" type=\"text\" id=\"paymentcntrl_ben_billingcity\" class=\"textbox\" /\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003eState:\u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cselect name=\"paymentcntrl$ben_billingstate\" id=\"paymentcntrl_ben_billingstate\" class=\"dropdown\"\u003e\r\n\t\u003coption value=\"\"\u003e\u003c/option\u003e\r\n\t\u003coption value=\"AL\"\u003eAL\u003c/option\u003e\r\n\t\u003coption value=\"AK\"\u003eAK\u003c/option\u003e\r\n\t\u003coption value=\"AZ\"\u003eAZ\u003c/option\u003e\r\n\t\u003coption value=\"AR\"\u003eAR\u003c/option\u003e\r\n\t\u003coption value=\"CA\"\u003eCA\u003c/option\u003e\r\n\t\u003coption value=\"CO\"\u003eCO\u003c/option\u003e\r\n\t\u003coption value=\"CT\"\u003eCT\u003c/option\u003e\r\n\t\u003coption value=\"DE\"\u003eDE\u003c/option\u003e\r\n\t\u003coption value=\"DC\"\u003eDC\u003c/option\u003e\r\n\t\u003coption value=\"FL\"\u003eFL\u003c/option\u003e\r\n\t\u003coption value=\"GA\"\u003eGA\u003c/option\u003e\r\n\t\u003coption value=\"HI\"\u003eHI\u003c/option\u003e\r\n\t\u003coption value=\"ID\"\u003eID\u003c/option\u003e\r\n\t\u003coption value=\"IL\"\u003eIL\u003c/option\u003e\r\n\t\u003coption value=\"IN\"\u003eIN\u003c/option\u003e\r\n\t\u003coption value=\"IA\"\u003eIA\u003c/option\u003e\r\n\t\u003coption value=\"KS\"\u003eKS\u003c/option\u003e\r\n\t\u003coption value=\"KY\"\u003eKY\u003c/option\u003e\r\n\t\u003coption value=\"LA\"\u003eLA\u003c/option\u003e\r\n\t\u003coption value=\"ME\"\u003eME\u003c/option\u003e\r\n\t\u003coption value=\"MD\"\u003eMD\u003c/option\u003e\r\n\t\u003coption value=\"MA\"\u003eMA\u003c/option\u003e\r\n\t\u003coption value=\"MI\"\u003eMI\u003c/option\u003e\r\n\t\u003coption value=\"MN\"\u003eMN\u003c/option\u003e\r\n\t\u003coption value=\"MS\"\u003eMS\u003c/option\u003e\r\n\t\u003coption value=\"MO\"\u003eMO\u003c/option\u003e\r\n\t\u003coption value=\"MT\"\u003eMT\u003c/option\u003e\r\n\t\u003coption value=\"NE\"\u003eNE\u003c/option\u003e\r\n\t\u003coption value=\"NV\"\u003eNV\u003c/option\u003e\r\n\t\u003coption value=\"NH\"\u003eNH\u003c/option\u003e\r\n\t\u003coption value=\"NJ\"\u003eNJ\u003c/option\u003e\r\n\t\u003coption value=\"NM\"\u003eNM\u003c/option\u003e\r\n\t\u003coption value=\"NY\"\u003eNY\u003c/option\u003e\r\n\t\u003coption value=\"NC\"\u003eNC\u003c/option\u003e\r\n\t\u003coption value=\"ND\"\u003eND\u003c/option\u003e\r\n\t\u003coption value=\"OH\"\u003eOH\u003c/option\u003e\r\n\t\u003coption value=\"OK\"\u003eOK\u003c/option\u003e\r\n\t\u003coption value=\"OR\"\u003eOR\u003c/option\u003e\r\n\t\u003coption value=\"PA\"\u003ePA\u003c/option\u003e\r\n\t\u003coption value=\"PR\"\u003ePR\u003c/option\u003e\r\n\t\u003coption value=\"RI\"\u003eRI\u003c/option\u003e\r\n\t\u003coption value=\"SC\"\u003eSC\u003c/option\u003e\r\n\t\u003coption value=\"SD\"\u003eSD\u003c/option\u003e\r\n\t\u003coption value=\"TN\"\u003eTN\u003c/option\u003e\r\n\t\u003coption value=\"TX\"\u003eTX\u003c/option\u003e\r\n\t\u003coption value=\"UT\"\u003eUT\u003c/option\u003e\r\n\t\u003coption value=\"VT\"\u003eVT\u003c/option\u003e\r\n\t\u003coption value=\"VA\"\u003eVA\u003c/option\u003e\r\n\t\u003coption value=\"WA\"\u003eWA\u003c/option\u003e\r\n\t\u003coption value=\"WV\"\u003eWV\u003c/option\u003e\r\n\t\u003coption value=\"WI\"\u003eWI\u003c/option\u003e\r\n\t\u003coption value=\"WY\"\u003eWY\u003c/option\u003e\r\n\r\n\u003c/select\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003eProvince:\u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cinput name=\"paymentcntrl$ben_billingprovince\" type=\"text\" id=\"paymentcntrl_ben_billingprovince\" class=\"textbox\" /\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003eZip/Postal Code:\u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cinput name=\"paymentcntrl$ben_billingzipcode\" type=\"text\" id=\"paymentcntrl_ben_billingzipcode\" class=\"textbox\" /\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv id=\"paymentcntrl_pnlLogInButton\" style=\"margin: 8px 0px;\"\u003e\r\n\t\r\n \u003ca href=\"javascript: void(0);\" onclick=\"benShowPopup(\u0027beninlinelogin\u0027);\"\u003eSign in to select saved payment methods\u003c/a\u003e\r\n \r\n\u003c/div\u003e\r\n \r\n \u003c/div\u003e\r\n \u003cdiv id=\"benpaymentwallet\" style=\"display: none; padding: 10px 0px;\"\u003e\r\n \u003cselect name=\"paymentcntrl$ddlWalletCards\" id=\"paymentcntrl_ddlWalletCards\" class=\"benddlpaymentwallet\"\u003e\r\n\t\u003coption value=\"\"\u003eSelect a card\u003c/option\u003e\r\n\r\n\u003c/select\u003e\r\n \u003cspan class=\"required\" aria-required=\"true\"\u003e*\u003c/span\u003e\r\n \u003cdiv style=\"padding-top: 10px;\"\u003e\r\n \u003ca href=\"javascript: void(0);\" onclick=\"jB(\u0027#benpaymentwallet\u0027).hide();jB(\u0027#benpaymentcreditcard\u0027).show();jB(\u0027.benddlpaymentwallet\u0027).val(\u00270\u0027);jB(\u0027.benddlpaymentwallet\u0027).rules(\u0027remove\u0027, \u0027required\u0027);jB(\u0027.benddlpaymentwallet\u0027).val(\u0027\u0027);\"\u003eEnter a new credit card number\u003c/a\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv id=\"beninlinelogin\" style=\"visibility: hidden;\" class=\"hideshow\"\u003e\r\n \u003cdiv class=\"benfade\"\u003e\r\n \u003c/div\u003e\r\n \u003cdiv class=\"popup_block\" style=\"padding: 5px; top: 50px; width: 400px; margin: 0 0 0 -205px;\"\u003e\r\n \u003cdiv class=\"popup\" style=\"position: relative; text-align: center;\"\u003e\r\n \u003ciframe id=\"beninlineloginiframe\"\r\n src=\"https://secure.engageddonor.com/p2p/login.aspx?c=3C6C4007-DD79-4FA2-9029-CE596895092D\"\r\n style=\"height: 340px; width: 340px; border-collapse: collapse; border: 0;\"\r\n frameBorder=\"0\" seamless=\"seamless\"\u003e\u003c/iframe\u003e\r\n \u003cdiv style=\"text-align: right;\"\u003e\r\n \u003ca class=\"button\" href=\"javascript: void(0);\" onclick=\"benLoadPayment();\"\u003eClose\u003c/a\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cscript type=\"text/javascript\"\u003e\r\n jQuery(document).ready(function () {\r\n //so popup element is at highest level in DOM so it appears on top of everything\r\n //benMoveToBodyElement(\"#beninlinelogin\");\r\n });\r\n \u003c/script\u003e\r\n\u003c/div\u003e\r\n\u003cinput name=\"hdfbenformtoken\" type=\"hidden\" id=\"hdfbenformtoken\" value=\"937788ce-5167-4643-b760-a8df731189ea\" /\u003e\r\n \u003cdiv id=\"benformprocessingfee\"\u003e\r\n \u003cinput type=\"checkbox\" onchange=\"jB(\u0027input[fieldtype=9]\u0027).prop(\u0027checked\u0027, jB(this).prop(\u0027checked\u0027));updateConditionsNew();\"/\u003e\u003cspan id=\"benformprocessingfeelabel\"\u003e\u003c/span\u003e\r\n \u003c/div\u003e\r\n \u003cdiv class=\"table full\"\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv class=\"benformtotalwrapper\"\u003eTotal: \u003cspan class=\"benformtotal\" style=\"font-weight: bold;\"\u003e\u003c/span\u003e\u003c/div\u003e\r\n \u003cdiv style=\"text-align: right;\"\u003e\r\n \u003cspan id=\"lblMisc\"\u003e\u003c/span\u003e\u003cspan id=\"lblError\" class=\"benformerror\" style=\"color:Red;\"\u003e\u003c/span\u003e\u0026nbsp;\u0026nbsp;\r\n \u003cinput name=\"b_form_submit\" type=\"button\" class=\"button\" value=\"Submit\" onclick=\"benValidateAndSubmit(this);\" /\u003e\r\n \r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cspan id=\"lblTotalAmountCharged\"\u003e\u003c/span\u003e\r\n\r\n \u003cdiv id=\"ben-g-recaptcha\" class=\"g-recaptcha\"\r\n data-sitekey=\"6LeLOCgUAAAAANXrCyQ5detYN8WXVPpqmDSOXToj\"\r\n data-callback=\"benSubmitFormRecaptcha\"\r\n data-size=\"invisible\"\u003e\r\n \u003c/div\u003e\r\n \u003cscript type=\"text/javascript\" src=\"https://www.google.com/recaptcha/api.js?render=explicit\" async defer\u003e\u003c/script\u003e\r\n \u003c/form\u003e\r\n \u003cdiv id=\"benFormLogin\" style=\"visibility: hidden;\" class=\"hideshow\"\u003e\r\n \u003cdiv class=\"benfade\"\u003e\r\n \u003c/div\u003e\r\n \u003cdiv class=\"popup_block\" style=\"padding: 5px;\"\u003e\r\n \u003cdiv class=\"popup\" style=\"position: relative;\"\u003e\r\n \r\n\r\n\u003cform id=\"benloginstatusform366\" method=\"post\" action=\"/p2p/login.ashx?rd=\"\u003e\r\n \u003cdiv class=\"table ben_login ben_loginstatus_login padded\"\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003e\r\n \u003ca href=\"https://www.facebook.com/v17.0/dialog/oauth?client_id=777699763907766\u0026redirect_uri=https%3A%2F%2Fsecure.engageddonor.com%2Fsocial%2Ffacebook.aspx\u0026state=%3ffor%3dauth%26c%3d3C6C4007-DD79-4FA2-9029-CE596895092D%26url%3d%26originalurl%3dhttps%253A%252F%252Faidsunited.org%252Frelief-recovery-resilience-fund%252F%2523login%252F%252F%252F1%26create%3d0\" id=\"ctl00_FacebookLoginLink\"\u003e\r\n \u003cimg id=\"ctl00_imgFacebookLogin\" src=\"https://secure.engageddonor.com/WebResource.axd?d=9B2wq4S4E8mP1dusrtKi9p-5JafiKI2TLr5JabXDiKd0gfjz4s56ZsUgXCLWzlH4bssFRwNAZKf8-QPBFiGKh8dSMLIMlFKuaMm5cnBlhG7ZzxLjSUjCHKrqPUTv4KVC8R09zwADVqt2XSyOBycFvnFolh0IyZZ0GaejAmShX1k1\u0026amp;t=638512848961367937\" style=\"width: 100%;\" /\u003e\u003c/a\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \r\n \u003cdiv\u003e\r\n \u003cdiv\u003e\r\n \u003cspan id=\"ctl00_lblSocialError\" class=\"bensocialerror\" style=\"color:Red;font-weight:bold;\"\u003e\u003c/span\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv style=\"font-weight: bold; font-size: 10px; padding: 18px 0px;\"\u003e\r\n \u003cdiv class=\"table full\"\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003e\r\n \u003chr /\u003e\r\n \u003c/div\u003e\r\n \u003cdiv style=\"width: 50px;\"\u003eOR\u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003chr /\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv style=\"padding: 4px; border: 1px solid #cccccc;\"\u003e\r\n \u003cinput name=\"ctl00$b_loginstatus_txtUsername\" type=\"text\" id=\"ctl00_b_loginstatus_txtUsername\" class=\"textbox benusername\" Placeholder=\"username\" style=\"width:100%;\" /\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv style=\"padding: 4px; border: 1px solid #cccccc;\"\u003e\r\n \u003cinput name=\"ctl00$b_loginstatus_txtPassword\" type=\"password\" id=\"ctl00_b_loginstatus_txtPassword\" class=\"textbox benpassword\" Placeholder=\"password\" style=\"width:100%;\" /\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003e\r\n\r\n \u003cinput id=\"b_loginstatus_btnSubmit\" type=\"button\" value=\"Login\" class=\"button small\" style=\"width: 100%;\" onclick=\u0027benAuthenticateUser(this, null);\u0027 /\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003e\r\n \u003cspan id=\"ctl00_lblError\" class=\"benerror\" style=\"color:Red;font-weight:bold;\"\u003e\u003c/span\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003cdiv\u003e\r\n \u003cdiv\u003e\r\n \u003ca href=\"javascript:benForgotPassword(\u0027benForgotPassword\u0027); benShowPopup(\u0027benForgotPassword\u0027);\"\u003eForgot password?\u003c/a\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \r\n \r\n \u003c/div\u003e\r\n\u003c/form\u003e\r\n\u003cdiv id=\"benForgotPassword\"\u003e\r\n \r\n\u003c/div\u003e\r\n\u003cscript type=\"text/javascript\"\u003e\r\n //so popup element is at highest level in DOM so it appears on top of everything\r\n benMoveToBodyElement(\"#benForgotPassword\");\r\n jB(document).ready(function () {\r\n });\r\n\u003c/script\u003e\r\n\r\n \u003cdiv style=\"text-align: right; margin-top: 20px;\"\u003e\r\n \u003cinput type=\"button\" class=\"button small cancel\" value=\"Close\" onclick=\"benHidePopup(\u0027benFormLogin\u0027);\" /\u003e\r\n \u003c/div\u003e\r\n \u003cstyle type=\"text/css\"\u003e\r\n #benFormLogin .ben_login {\r\n margin: 0px auto;\r\n width: auto;\r\n }\r\n \u003c/style\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n \u003c/div\u003e\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\u003cscript type=\"text/javascript\"\u003e\r\n jQuery(document).ready(function () {\r\n formLoadComplete(\u0027benforminput\u0027, true);bindEnterClick(jB(\u0027#pnlDiscountCode\u0027), jB(\u0027#b_form_applydiscountcode\u0027));\r\n });\r\n\u003c/script\u003e\r\n\u003cscript type=\"text/javascript\"\u003e\r\n jB(document).ready(function () {\r\n //so popup element is at highest level in DOM so it appears on top of everything\r\n //benMoveToBodyElement(\"#benAlreadyRegistered\");\r\n //benMoveToBodyElement(\"#benFormLoggedIn\");\r\n benMoveToBodyElement(\"#benFormLogin\");\r\n });\r\n\u003c/script\u003e\r\n\u003cscript type=\"text/javascript\"\u003ejB(\u0027.benforminput\u0027).change(function() { benFormT(this); });\u003c/script\u003e","recordID":""})