{"id":2,"date":"2018-03-25T13:35:41","date_gmt":"2018-03-25T13:35:41","guid":{"rendered":"https:\/\/cers.wisgopsenate.com\/donatevanw\/?page_id=2"},"modified":"2020-09-09T14:38:13","modified_gmt":"2020-09-09T14:38:13","slug":"sample-page","status":"publish","type":"page","link":"https:\/\/cers.wisgopsenate.com\/donatevanw\/","title":{"rendered":"Donate"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_1' style='display:none'><div id='gf_1' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_1' id='gform_1'  action='\/donatevanw\/wp-json\/wp\/v2\/pages\/2\/#gf_1' data-formid='1' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_1_15\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_15\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><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_1_15'>\n                            \n                            <span id='input_1_15_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_15.3' id='input_1_15_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_15_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_15_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_15.6' id='input_1_15_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_15_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_1_16\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_16\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_1_16' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_16_1_container' >\n                                        <input type='text' name='input_16.1' id='input_1_16_1' value=''    aria-required='true'    \/>\n                                        <label for='input_1_16_1' id='input_1_16_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_1_16_2_container' >\n                                        <input type='text' name='input_16.2' id='input_1_16_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_16_2' id='input_1_16_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_16_3_container' >\n                                    <input type='text' name='input_16.3' id='input_1_16_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_16_3' id='input_1_16_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_1_16_4_container' >\n                                        <select name='input_16.4' id='input_1_16_4'     aria-required='true'    ><option value='' ><\/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' selected='selected'>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_1_16_4' id='input_1_16_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_1_16_5_container' >\n                                    <input type='text' name='input_16.5' id='input_1_16_5' value=''    aria-required='true'    \/>\n                                    <label for='input_1_16_5' id='input_1_16_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_16.6' id='input_1_16_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_1_17\" class=\"gfield gfield--type-email gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_17\" ><label class='gfield_label gform-field-label' for='input_1_17'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_17' id='input_1_17' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_1_18\" class=\"gfield gfield--type-phone gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_18\" ><label class='gfield_label gform-field-label' for='input_1_18'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_18' id='input_1_18' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_20\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_list_inline gfield_price gfield_price_1_20 gfield_product_1_20 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_20\" ><label class='gfield_label gform-field-label' >Donation Amount<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_20'>\n\t\t\t<li class='gchoice gchoice_1_20_0'>\n\t\t\t\t<input name='input_20' type='radio' value='$10|10'  id='choice_1_20_0'    \/>\n\t\t\t\t<label for='choice_1_20_0' id='label_1_20_0' class='gform-field-label gform-field-label--type-inline'><img src=\"https:\/\/wisracc.org\/wp-content\/uploads\/2018\/03\/donation-amounts10.png\" width=\"95\" height=\"42\" \/><\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_1'>\n\t\t\t\t<input name='input_20' type='radio' value='$25|25'  id='choice_1_20_1'    \/>\n\t\t\t\t<label for='choice_1_20_1' id='label_1_20_1' class='gform-field-label gform-field-label--type-inline'><img src=\"https:\/\/wisracc.org\/wp-content\/uploads\/2018\/03\/donation-amounts25.png\" width=\"95\" height=\"42\" \/><\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_2'>\n\t\t\t\t<input name='input_20' type='radio' value='$50|50'  id='choice_1_20_2'    \/>\n\t\t\t\t<label for='choice_1_20_2' id='label_1_20_2' class='gform-field-label gform-field-label--type-inline'><img src=\"https:\/\/wisracc.org\/wp-content\/uploads\/2018\/03\/donation-amounts50.png\" width=\"95\" height=\"42\" \/><\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_3'>\n\t\t\t\t<input name='input_20' type='radio' value='$100|100'  id='choice_1_20_3'    \/>\n\t\t\t\t<label for='choice_1_20_3' id='label_1_20_3' class='gform-field-label gform-field-label--type-inline'><img src=\"https:\/\/wisracc.org\/wp-content\/uploads\/2018\/03\/donation-amounts100.png\" width=\"95\" height=\"42\" \/><\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_4'>\n\t\t\t\t<input name='input_20' type='radio' value='$200.00|200'  id='choice_1_20_4'    \/>\n\t\t\t\t<label for='choice_1_20_4' id='label_1_20_4' class='gform-field-label gform-field-label--type-inline'><img src=\"https:\/\/wisracc.org\/wp-content\/uploads\/2018\/03\/donation-amounts200.png\" width=\"95\" height=\"42\" \/><\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_5'>\n\t\t\t\t<input name='input_20' type='radio' value='$500.00|500'  id='choice_1_20_5'    \/>\n\t\t\t\t<label for='choice_1_20_5' id='label_1_20_5' class='gform-field-label gform-field-label--type-inline'><img src=\"https:\/\/wisracc.org\/wp-content\/uploads\/2018\/03\/donation-amounts500.png\" width=\"95\" height=\"42\" \/><\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_6'>\n\t\t\t\t<input name='input_20' type='radio' value='$1000.00|1000'  id='choice_1_20_6'    \/>\n\t\t\t\t<label for='choice_1_20_6' id='label_1_20_6' class='gform-field-label gform-field-label--type-inline'><img src=\"https:\/\/wisracc.org\/wp-content\/uploads\/2018\/03\/donation-amounts1000.png\" width=\"95\" height=\"42\" \/><\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_7'>\n\t\t\t\t<input name='input_20' type='radio' value='$2000.00|2000'  id='choice_1_20_7'    \/>\n\t\t\t\t<label for='choice_1_20_7' id='label_1_20_7' class='gform-field-label gform-field-label--type-inline'><img src=\"https:\/\/wisracc.org\/wp-content\/uploads\/2018\/03\/donation-amounts2000.png\" width=\"95\" height=\"42\" \/><\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_8'>\n\t\t\t\t<input name='input_20' type='radio' value='Other Amount|0'  id='choice_1_20_8'    \/>\n\t\t\t\t<label for='choice_1_20_8' id='label_1_20_8' class='gform-field-label gform-field-label--type-inline'><img src=\"https:\/\/wisracc.org\/wp-content\/uploads\/2018\/03\/donation-amountsother.png\" width=\"95\" height=\"42\" \/><\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_28\" class=\"gfield gfield--type-product gfield--input-type-price gfield_price gfield_price_1_28 gfield_product_1_28 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_28\" ><label class='gfield_label gform-field-label' for='input_1_28'>Other Amount<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_product_price'>\n\t\t\t\t\t<input name='input_28' id='input_1_28' type='text' value='' class='medium ginput_amount'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/li><li id=\"field_1_30\" class=\"gfield gfield--type-total gf_left_third gfield_price gfield_price_1_ gfield_total gfield_total_1_ field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" data-js-reload=\"field_1_30\" ><label class='gfield_label gform-field-label' for='input_1_30'>Total<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<span class='ginput_total ginput_total_1'>$0.00<\/span>\n\t\t\t\t\t\t\t<input type='hidden' name='input_30' id='input_1_30' class='gform_hidden'\/>\n\t\t\t\t\t\t<\/div><\/li><li id=\"field_1_31\" class=\"gfield gfield--type-radio gfield--type-choice gf_middle_third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_31\" ><label class='gfield_label gform-field-label' >Is your donation amount $200.00 or more?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_31'>\n\t\t\t<li class='gchoice gchoice_1_31_0'>\n\t\t\t\t<input name='input_31' type='radio' value='Yes, my donation is over $200.00'  id='choice_1_31_0'    \/>\n\t\t\t\t<label for='choice_1_31_0' id='label_1_31_0' class='gform-field-label gform-field-label--type-inline'>Yes, my donation is over $200.00<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_31_1'>\n\t\t\t\t<input name='input_31' type='radio' value='No'  id='choice_1_31_1'    \/>\n\t\t\t\t<label for='choice_1_31_1' id='label_1_31_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_11\" class=\"gfield gfield--type-text gf_right_third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_11\" ><label class='gfield_label gform-field-label' for='input_1_11'>If your donation is $200 or more, please enter your occupation<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_1_11' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_32\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_32\" ><label class='gfield_label gform-field-label' >Payment Method<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_32'>\n\t\t\t<li class='gchoice gchoice_1_32_0'>\n\t\t\t\t<input name='input_32' type='radio' value='Credit or Debit Card'  id='choice_1_32_0'    \/>\n\t\t\t\t<label for='choice_1_32_0' id='label_1_32_0' class='gform-field-label gform-field-label--type-inline'>Credit or Debit Card<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_32_1'>\n\t\t\t\t<input name='input_32' type='radio' value='eCheck or ACH'  id='choice_1_32_1'    \/>\n\t\t\t\t<label for='choice_1_32_1' id='label_1_32_1' class='gform-field-label gform-field-label--type-inline'>eCheck or ACH<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_26\" class=\"gfield gfield--type-creditcard field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_26\" ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_1_26_1'>Credit or Debit Card<\/label><div class='ginput_complex ginput_container ginput_container_creditcard gform-grid-row' id='input_1_26'><span class='ginput_full gform-grid-col' id='input_1_26_1_container' >\n                                    <div class='gform_card_icon_container'><div class='gform_card_icon gform_card_icon_amex' >American Express<\/div><div class='gform_card_icon gform_card_icon_discover' >Discover<\/div><div class='gform_card_icon gform_card_icon_mastercard' >MasterCard<\/div><div class='gform_card_icon gform_card_icon_visa' >Visa<\/div><span class='screen-reader-text' id='field_1_26_supported_creditcards'>Supported Credit Cards: American Express, Discover, MasterCard, Visa<\/span><\/div>\n                                    <input type='text' name='input_26.1' id='input_1_26_1' value=''   onchange='gformMatchCard(\"input_1_26_1\");' onkeyup='gformMatchCard(\"input_1_26_1\");' autocomplete='off' pattern='[0-9]*' title='Only digits are allowed'  aria-required='false'  \/>\n                                    <label for='input_1_26_1' id='input_1_26_1_label' class='gform-field-label gform-field-label--type-sub '>Card Number<\/label>\n                                 <\/span><span class='ginput_full ginput_cardextras gform-grid-col gform-grid-row' id='input_1_26_2_container'>\n                                            <span class='ginput_cardinfo_left' id='input_1_26_2_cardinfo_left'>\n                                                <span class='ginput_card_expiration_container ginput_card_field'>\n                                                    \n                                                       <select name='input_26.2[]' id='input_1_26_2_month'   class='ginput_card_expiration ginput_card_expiration_month' aria-required='false'  >\n                                                           <option value=''>Month<\/option><option value='1' >01<\/option><option value='2' >02<\/option><option value='3' >03<\/option><option value='4' >04<\/option><option value='5' >05<\/option><option value='6' >06<\/option><option value='7' >07<\/option><option value='8' >08<\/option><option value='9' >09<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option>\n                                                       <\/select>\n                                                       \n                                                   \n                                                   \n                                                       <select name='input_26.2[]' id='input_1_26_2_year'   class='ginput_card_expiration ginput_card_expiration_year' aria-required='false'  >\n                                                           <option value=''>Year<\/option><option value='2024' >2024<\/option><option value='2025' >2025<\/option><option value='2026' >2026<\/option><option value='2027' >2027<\/option><option value='2028' >2028<\/option><option value='2029' >2029<\/option><option value='2030' >2030<\/option><option value='2031' >2031<\/option><option value='2032' >2032<\/option><option value='2033' >2033<\/option><option value='2034' >2034<\/option><option value='2035' >2035<\/option><option value='2036' >2036<\/option><option value='2037' >2037<\/option><option value='2038' >2038<\/option><option value='2039' >2039<\/option><option value='2040' >2040<\/option><option value='2041' >2041<\/option><option value='2042' >2042<\/option><option value='2043' >2043<\/option>\n                                                       <\/select>\n                                                       \n                                                       \n                                                <\/span>\n                                                 <label for='input_1_26_2_month' class='gform-field-label gform-field-label--type-sub '>Expiration Date<\/label>\n       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<label for='input_1_26_5' id='input_1_26_5_label' class='gform-field-label gform-field-label--type-sub '>Cardholder Name<\/label>\n                                        <\/span> <\/div><\/li><li id=\"field_1_27\" class=\"gfield gfield--type-az_echeck field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_27\" ><label class='gfield_label gform-field-label' for='input_1_27'>eCheck or ACH<\/label><div class='ginput_complex ginput_container' id='input_1_27'><span class='ginput_full' id='input_1_27_4_container' >\r\n                                    <input type='text' name='input_27.4' id='input_1_27_4' value=''     autocomplete='off'  title='The name on your account' \/>\r\n                                    <label for='input_1_27_4' id='input_1_27_4_label' >Name on Account<\/label>\r\n                                 <\/span><span class='ginput_full' id='input_1_27_2_container' >\r\n                                    <input type='text' name='input_27.2' id='input_1_27_2' value=''     autocomplete='off' title='Your bank name' \/>\r\n                                    <label for='input_1_27_2' id='input_1_27_2_label' >Bank Name<\/label>\r\n                                 <\/span><span class='ginput_full' id='input_1_27_1_container' >\r\n                                    <input type='text' name='input_27.1' id='input_1_27_1' value=''     autocomplete='off'  \/>\r\n                                    <label for='input_1_27_1' id='input_1_27_1_label' >Routing Number<\/label>\r\n                                 <\/span><span class='ginput_full' id='input_1_27_3_container' >\r\n                                    <input type='text' name='input_27.3' id='input_1_27_3' value=''     autocomplete='off'  title='The account number' \/>\r\n                                    <label for='input_1_27_3' id='input_1_27_3_label' >Account Number<\/label>\r\n                                 <\/span><span class='ginput_full' id='input_1_27_5_container' ><select  name='input_27_5' id='input_1_27_5' ><option value='checking' >Checking<\/option><option value='savings' >Savings<\/option><\/select><label id='input_1_27_5_label' for='input_1_27_5'>Account Type<\/label><\/span> <div class=\"gfield_description validation_message\"><\/div><\/div><\/li><li id=\"field_1_13\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_13\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Donation Terms<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_13'>State and Federal Law requires that you verify the following statements are true and accurate by checking the box below.<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_13'><li class='gchoice gchoice_1_13_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.1' type='checkbox'  value='By checking this box, I certify this is my personal credit card not funded by a corporation or other prohibited source.  This contribution will not be reimbursed by anyone else and will not cause my contribution to this candidate to exceed the $2,000 per individual or $4,000 per couple contribution limit to a Wisconsin State Senate campaign.  Contributions from a corporation are prohibited and state campaign contributions are not tax deductible.'  id='choice_1_13_1'   aria-describedby=\"gfield_description_1_13\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_13_1' id='label_1_13_1' class='gform-field-label gform-field-label--type-inline'>By checking this box, I certify this is my personal credit card not funded by a corporation or other prohibited source.  This contribution will not be reimbursed by anyone else and will not cause my contribution to this candidate to exceed the $2,000 per individual or $4,000 per couple contribution limit to a Wisconsin State Senate campaign.  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