<div class="wfp-container"> <div class="wfp-view wfp-view-public"> <div class="wfdp-donation-form " id=""> <form method="post" class="wfdp-donationForm" id="wfdp-donationForm-971" wfp-data-url="https://gwinnettrepublicans.com/wfp-checkout?wfpout=true" wfp-payment-type="default"> <div class='xs-modal-body wfp-donation-form-wraper'> <div class="wfp-modal-header"> <!-- Before Content--> <div class="wfp-post-image"> </div> <!-- After Content--> <h4 class="wfp-post-title">Your Donation</h4> <div class="wfp-excerpt-section"> <div class="wfp-post-excerpt"></div> </div> <hr class="wfp-normal-separator" style="margin: 20px 0;" /> </div> <div class="wfdp-donation-message" ></div> <div class="wfdp-donation-input-form xs-multi-lebel" > <div class="xs-donate-field-wrap-group"> <div class="xs-donate-field-wrap"> <label for="xs_donate_amount" class="xs-money-symbol xs-money-symbol-before">$</label> <input type="number" required min="0" onkeyup="xs_additional_fees(this.value, 971)" onblur="xs_additional_fees(this.value, 971)" name="xs_donate_data_submit[donate_amount]" id="xs_donate_amount" placeholder="1.00" class="xs-field xs-money-field xs-text_small"> </div> </div> <ul class="wfp-bdage-list"> <li class="wfp-bdage" onclick="xs_donate_amount_set(15.00, 971);" data-value="15.00" class="">15.00</li> <li class="wfp-bdage" onclick="xs_donate_amount_set(35.00, 971);" data-value="35.00" class="donate-active">35.00</li> <li class="wfp-bdage" onclick="xs_donate_amount_set(50.00, 971);" data-value="50.00" class="">50.00</li> <li class="wfp-bdage" onclick="xs_donate_amount_set(100.00, 971);" data-value="100.00" class="">100.00</li> <li class="wfp-bdage" onclick="xs_donate_amount_set(200.00, 971);" data-value="200.00" class="">200.00</li> <li class="wfp-bdage" onclick="xs_donate_amount_set(0, 971);" data-value="0" class="">Custom</li> </ul> </div> <div class="wfdp-donation-input-form wfp-input-field wfp-text "> <label for="xs-first_name"> First Name</label> <input type="text" class="regular-text" name="xs_donate_data_submit[additonal][first_name]" value="" id="xs-first_name" required /> </div> <div class="wfdp-donation-input-form wfp-input-field wfp-text "> <label for="xs-last_name"> Last Name</label> <input type="text" class="regular-text" name="xs_donate_data_submit[additonal][last_name]" value="" id="xs-last_name" required /> </div> <div class="wfdp-donation-input-form wfp-input-field wfp-text "> <label for="xs-email_address"> Email Address</label> <input type="text" class="regular-text" name="xs_donate_data_submit[additonal][email_address]" value="" id="xs-email_address" required /> </div> <div class="wfdp-donation-input-form wfp-input-field wfp-text "> <label for="xs-address_line_1"> Address Line 1</label> <input type="text" class="regular-text" name="xs_donate_data_submit[additonal][address_line_1]" value="" id="xs-address_line_1" required /> </div> <div class="wfdp-donation-input-form wfp-input-field wfp-text "> <label for="xs-address_line_2"> Address Line 2</label> <input type="text" class="regular-text" name="xs_donate_data_submit[additonal][address_line_2]" value="" id="xs-address_line_2" required /> </div> <div class="wfdp-donation-input-form wfp-input-field wfp-text "> <label for="xs-city"> City</label> <input type="text" class="regular-text" name="xs_donate_data_submit[additonal][city]" value="" id="xs-city" required /> </div> <div class="wfdp-donation-input-form wfp-input-field wfp-text "> <label for="xs-state"> State</label> <input type="text" class="regular-text" name="xs_donate_data_submit[additonal][state]" value="" id="xs-state" required /> </div> <div class="wfdp-donation-input-form wfp-input-field wfp-text "> <label for="xs-zip"> ZIP</label> <input type="text" class="regular-text" name="xs_donate_data_submit[additonal][zip]" value="" id="xs-zip" required /> </div> <div class="wfdp-donation-input-form wfdp-input-payment-field-wraper "> <div class="wfdp-input-payment-field"> <span class=""> Select Payment Method:</span> <ul class="xs-donate-display-amount wfp-radio-input-style-2"> <li> <input class="xs_radio_filed" id="wfp_cash" type="radio" name="xs_donate_data_submit[payment_method]" checked value="offline_payment" onchange="xs_show_hide_multiple_div('.payment_method_info', '.method-offline_payment');"> <label for="wfp_cash">Cash</label> </li> <li> <input class="xs_radio_filed" id="wfp_paypal" type="radio" name="xs_donate_data_submit[payment_method]" value="online_payment" onchange="xs_show_hide_multiple_div('.payment_method_info', '.method-online_payment');"> <label for="wfp_paypal">Paypal</label> </li> </ul> </div> </div> <div class="wfdp-input-payment-field wfdp-donation-payment-details "> <div class="xs-donate-display-amount"> <div class="payment_method_info method-offline_payment xs-donate-hidden xs-donate-visible"> <h2 class="wfp-payment-method-title fdas">Cash </h2> <div class="wfp-payment-method-acc-details"> <strong class="wfp-payment-method-acc-details--title">Details:</strong> <span class="wfp-payment-method-acc-details--description">Cash sed ut perspiciatis unde omnis iste natus error sit voluptatem accusantium doloremque laudantium, totam rem aperiam, eaque ipsa quae ab illo inventore veritatis et quasi architecto beatae vitae dicta sunt explicabo. Nemo enim ipsam voluptatem quia voluptas sit aspernatur aut odit aut fugit, sed quia consequuntur magni dolores eos qui ratione voluptatem sequi nesciunt.</span> </div> </div> <div class="payment_method_info method-online_payment xs-donate-hidden "> <h2 class="wfp-payment-method-title fdas">Paypal </h2> <div class="wfp-payment-method-acc-details"> <strong class="wfp-payment-method-acc-details--title">Details:</strong> <span class="wfp-payment-method-acc-details--description">Paypal sed voluptatem quia voluptas sit aspernatur aut odit aut fugit, sed quia consequuntur magni dolores eos qui ratione voluptatem sequi nesciunt ut perspiciatis unde omnis iste natus error sit voluptatem accusantium doloremque laudantium, totam rem aperiam, eaque ipsa quae ab illo inventore veritatis et quasi architecto beatae vitae dicta sunt explicabo nemo enim ipsam .</span> </div> </div> </div> </div></div> <div class="wfp-donate-form-footer"> <div class="wfdp-donation-input-form"> <button type="submit" class="xs-btn btn-special submit-btn" name="submit-form-donation"> Donate Now </button> </div> </div> </form> </div> </div> <script type='text/javascript'> xs_donate_amount_set(35.00,971); </script> </div>