{"id":1605,"date":"2021-09-26T19:50:01","date_gmt":"2021-09-26T19:50:01","guid":{"rendered":"https:\/\/bijoygarhbharatmata.com\/?page_id=1605"},"modified":"2021-09-26T19:53:19","modified_gmt":"2021-09-26T19:53:19","slug":"bharatmata-digital-contact-form","status":"publish","type":"page","link":"https:\/\/bijoygarhbharatmata.com\/index.php\/bharatmata-digital-contact-form\/","title":{"rendered":"Bharatmata Digital Contact Form"},"content":{"rendered":"<div class='fluentform fluentform_wrapper_3'><form data-form_id=\"3\" id=\"fluentform_3\" class=\"frm-fluent-form fluent_form_3 ff-el-form-top ff_form_instance_3_1 ff-form-loading ff-form-has-steps fluentform_has_payment\" data-form_instance=\"ff_form_instance_3_1\" method=\"POST\" ><input type='hidden' name='__fluent_form_embded_post_id' value='1605' \/><input type=\"hidden\" id=\"_fluentform_3_fluentformnonce\" name=\"_fluentform_3_fluentformnonce\" value=\"95d9dbf939\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/1605\" \/><div class='ff-step-container' data-name=\"step_start-3_9\" data-disable_auto_focus=\"no\" data-enable_auto_slider=\"no\" data-enable_step_data_persistency=\"yes\" data-enable_step_page_resume=\"no\" ><div class='ff-step-header'><div class='ff-el-progress-status'><\/div>\n            <div class='ff-el-progress'>\n                <div class='ff-el-progress-bar'><span><\/span><\/div>\n            <\/div>\n            <ul style='display: none' class='ff-el-progress-title'>\n                <li>Collector Information<\/li><li>Client Information<\/li><li>Advertisement Content Information<\/li><li>Payment Summary<\/li>\n            <\/ul><\/div><span class='ff_step_start'><\/span><div class='ff-step-body'><div class=\"fluentform-step active\" data-name=\"step_start-3_9\" data-disable_auto_focus=\"no\" data-enable_auto_slider=\"no\" data-enable_step_data_persistency=\"yes\" data-enable_step_page_resume=\"no\" ><div class=\"ff-el-group ff-el-section-break  ff_center\" data-name=\"section_break-3_1\" ><h3 class='ff-el-section-title'>Collector Information<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_3  '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 34%;'><div class='ff-el-group'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_3_input_text'>Name<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" placeholder=\"Name\" data-name=\"input_text\" id=\"ff_3_input_text\" ><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 34%;'><div class='ff-el-group'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_3_email'>Email<\/label> <\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_3_email\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email\" ><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 34%;'><div class='ff-el-group'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_3_phone'>Phone\/Mobile<\/label> <\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone ff_el_with_extended_validation\" type=\"tel\" placeholder=\"Mobile Number\" data-name=\"phone\" id=\"ff_3_phone\" inputmode=\"tel\" ><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_2  '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_3_dropdown_2'>Collection Type<\/label> <\/div><div class='ff-el-input--content'><select name=\"dropdown_2\" id=\"ff_3_dropdown_2\" class=\"ff-el-form-control\" data-name=\"dropdown_2\" data-calc_value=\"0\" ><option value=\"\">- Select -<\/option><option value=\"Donation\"  >Donation<\/option><option value=\"Contact Form\"  >Contact Form<\/option><\/select><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary'>Previous<\/button><button  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary'>Next<\/button><\/div><\/div><div class=\" fluentform-step\" data-name=\"form_step-3_2\" ><div class=\"ff-el-group ff-el-section-break  ff_center\" data-name=\"section_break-3_3\" ><h3 class='ff-el-section-title'>Client Information<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_3  '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 34%;'><div class='ff-el-group'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_3_input_text_1'>Name<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" placeholder=\"Name\" data-name=\"input_text_1\" id=\"ff_3_input_text_1\" ><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 34%;'><div class='ff-el-group'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_3_email_1'>Email<\/label> <\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email_1\" id=\"ff_3_email_1\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email_1\" ><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 34%;'><div class='ff-el-group'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_3_phone_1'>Phone\/Mobile<\/label> <\/div><div class='ff-el-input--content'><input name=\"phone_1\" class=\"ff-el-form-control ff-el-phone ff_el_with_extended_validation\" type=\"tel\" placeholder=\"Mobile Number\" data-name=\"phone_1\" id=\"ff_3_phone_1\" inputmode=\"tel\" ><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary'>Previous<\/button><button  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary'>Next<\/button><\/div><\/div><div class=\" fluentform-step\" data-name=\"form_step-3_4\" ><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_center\" data-name=\"section_break-3_5\" ><h3 class='ff-el-section-title'>Creative Content Information<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div data-name=\"ff_cn_id_4\"  class='ff-t-container ff-column-container ff_columns_total_2  '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class='ff-el-input--label asterisk-right'><label for='ff_3_dropdown'>Creative Design<\/label> <\/div><div class='ff-el-input--content'><select name=\"dropdown\" id=\"ff_3_dropdown\" class=\"ff-el-form-control\" data-name=\"dropdown\" data-calc_value=\"0\" ><option value=\"\">- Select -<\/option><option value=\"I have my own creative design\"  >I have my own creative design<\/option><option value=\"I dont have any design and I want to make a new one\"  >I dont have any design and I want to make a new one<\/option><\/select><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class='ff-el-input--label asterisk-right'><label for='ff_3_image-upload_1'>Image Upload<\/label> <\/div><div class='ff-el-input--content'><label for='ff_3_image-upload_1' class='ff_file_upload_holder'><span class='ff_upload_btn ff-btn'>Choose File<\/span> <input type=\"file\" name=\"image-upload\" id=\"ff_3_image-upload_1\" class=\"ff-el-form-control  ff-screen-reader-element\" accept=\"image\/*\" data-name=\"image-upload\" multiple=\"1\" ><\/label><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class='ff-el-input--label asterisk-right'><label for='ff_3_description'>Content<\/label> <\/div><div class='ff-el-input--content'><textarea name=\"description\" id=\"ff_3_description\" class=\"ff-el-form-control\" placeholder=\"Please type your content here\" rows=\"5\" cols=\"2\" data-name=\"description\" ><\/textarea><\/div><\/div><div class='step-nav ff_step_nav_last'><button  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary'>Previous<\/button><button  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary'>Next<\/button><\/div><\/div><div class=\" fluentform-step\" data-name=\"form_step-3_6\" ><div class=\"ff-el-group ff-el-section-break  ff_center\" data-name=\"section_break-3_7\" ><h3 class='ff-el-section-title'>Payment Summary<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div data-name=\"ff_cn_id_5\"  class='ff-t-container ff-column-container ff_columns_total_2  '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class='ff-el-input--label asterisk-right'><label for='ff_3_dropdown_1'>Contact From Type<\/label> <\/div><div class='ff-el-input--content'><select name=\"dropdown_1\" id=\"ff_3_dropdown_1\" class=\"ff-el-form-control\" data-name=\"dropdown_1\" data-calc_value=\"0\" ><option value=\"\">- Please Select -<\/option><option value=\"General Contact Form\"  >General Contact Form<\/option><option value=\"Special Contact Form\"  >Special Contact Form<\/option><\/select><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label >General Contact Form Payment Items<\/label> <\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_11d793d43f8694c1ff66cb7dedcc0007><input type=\"radio\" name=\"payment_input\" data-name=\"payment_input\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item\" value=\"Platinum Page : 25,000\" data-payment_value=\"25000\" data-calc_value=\"25000\" data-group_id=\"ff_3_payment_input\"  id='payment_input_11d793d43f8694c1ff66cb7dedcc0007'> <span class='ff_plan_title'>Platinum Page : 25,000<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_a60ee1195919ceb0f9d2b48cd52417f5><input type=\"radio\" name=\"payment_input\" data-name=\"payment_input\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item ff_payment_item\" value=\"Golden Page : 20,000\" data-payment_value=\"20000\" data-calc_value=\"20000\" data-group_id=\"ff_3_payment_input\"  id='payment_input_a60ee1195919ceb0f9d2b48cd52417f5'> <span class='ff_plan_title'>Golden Page : 20,000<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_2b2b9beff2262edd0e16f8b836e52135><input type=\"radio\" name=\"payment_input\" data-name=\"payment_input\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item ff_payment_item ff_payment_item\" value=\"Front Cover (Inside) : 15,000\" data-payment_value=\"15000\" data-calc_value=\"15000\" data-group_id=\"ff_3_payment_input\"  id='payment_input_2b2b9beff2262edd0e16f8b836e52135'> <span class='ff_plan_title'>Front Cover (Inside) : 15,000<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_ba2d133ced5c0c8d5784fab9e5b2ebe9><input type=\"radio\" name=\"payment_input\" data-name=\"payment_input\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item ff_payment_item ff_payment_item ff_payment_item\" value=\"Back Cover (Inside) : 10,000\" data-payment_value=\"10000\" data-calc_value=\"10000\" data-group_id=\"ff_3_payment_input\"  id='payment_input_ba2d133ced5c0c8d5784fab9e5b2ebe9'> <span class='ff_plan_title'>Back Cover (Inside) : 10,000<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_ec8c00d26b8e0f964d14be8a3029ed4a><input type=\"radio\" name=\"payment_input\" data-name=\"payment_input\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item\" value=\"Back Cover (Outside) : 20,000\" data-payment_value=\"20000\" data-calc_value=\"20000\" data-group_id=\"ff_3_payment_input\"  id='payment_input_ec8c00d26b8e0f964d14be8a3029ed4a'> <span class='ff_plan_title'>Back Cover (Outside) : 20,000<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_ba7808caef6ad3869ad241e3e5489509><input type=\"radio\" name=\"payment_input\" data-name=\"payment_input\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item\" value=\"Prestige Page : 9,000\" data-payment_value=\"9000\" data-calc_value=\"9000\" data-group_id=\"ff_3_payment_input\"  id='payment_input_ba7808caef6ad3869ad241e3e5489509'> <span class='ff_plan_title'>Prestige Page : 9,000<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_fc541a20608589eb5fd6efb4d92e5f4f><input type=\"radio\" name=\"payment_input\" data-name=\"payment_input\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item\" value=\"Full Page : 5,000\" data-payment_value=\"5000\" data-calc_value=\"5000\" data-group_id=\"ff_3_payment_input\"  id='payment_input_fc541a20608589eb5fd6efb4d92e5f4f'> <span class='ff_plan_title'>Full Page : 5,000<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_5808a9fd0f287004111d8336ecbe009a><input type=\"radio\" name=\"payment_input\" data-name=\"payment_input\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item\" value=\"Half Page : 3,000\" data-payment_value=\"3000\" data-calc_value=\"3000\" data-group_id=\"ff_3_payment_input\"  id='payment_input_5808a9fd0f287004111d8336ecbe009a'> <span class='ff_plan_title'>Half Page : 3,000<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_ee95e96cdf8c5271bdab14d11e02572f><input type=\"radio\" name=\"payment_input\" data-name=\"payment_input\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item\" value=\"Quarter Page : 2,000\" data-payment_value=\"2000\" data-calc_value=\"2000\" data-group_id=\"ff_3_payment_input\"  id='payment_input_ee95e96cdf8c5271bdab14d11e02572f'> <span class='ff_plan_title'>Quarter Page : 2,000<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_3_item-quantity'>Quantity<\/label> <\/div><div class='ff-el-input--content'><input type=\"number\" name=\"item-quantity\" id=\"ff_3_item-quantity\" class=\"ff-el-form-control  ff_quantity_item\" data-quantity_item=\"yes\" data-name=\"item-quantity\" data-target_product=\"payment_input\" ><\/div><\/div><div class='ff-el-group has-conditions'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label >Special Contact Form Payment Items<\/label> <\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_1_c74c244dc3b9482e92e58e1f82c251f0><input type=\"radio\" name=\"payment_input_1\" data-name=\"payment_input_1\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item\" value=\"Platinum Page : 50,000\" data-payment_value=\"50000\" data-calc_value=\"50000\" data-group_id=\"ff_3_payment_input_1\"  id='payment_input_1_c74c244dc3b9482e92e58e1f82c251f0'> <span class='ff_plan_title'>Platinum Page : 50,000<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_1_6cf860ab4f145dc1dcbea449344da5f7><input type=\"radio\" name=\"payment_input_1\" data-name=\"payment_input_1\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item ff_payment_item\" value=\"Golden Page : 40,000\" data-payment_value=\"40000\" data-calc_value=\"40000\" data-group_id=\"ff_3_payment_input_1\"  id='payment_input_1_6cf860ab4f145dc1dcbea449344da5f7'> <span class='ff_plan_title'>Golden Page : 40,000<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_1_cd43c69cfd56215ee705c7249024dd90><input type=\"radio\" name=\"payment_input_1\" data-name=\"payment_input_1\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item ff_payment_item ff_payment_item\" value=\"Front Cover (Inside) : 25,000\" data-payment_value=\"25000\" data-calc_value=\"25000\" data-group_id=\"ff_3_payment_input_1\"  id='payment_input_1_cd43c69cfd56215ee705c7249024dd90'> <span class='ff_plan_title'>Front Cover (Inside) : 25,000<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_1_cf5c5f925d5558aedfa51ad74c95c9de><input type=\"radio\" name=\"payment_input_1\" data-name=\"payment_input_1\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item ff_payment_item ff_payment_item ff_payment_item\" value=\"Back Cover (Inside) : 20,000\" data-payment_value=\"20000\" data-calc_value=\"20000\" data-group_id=\"ff_3_payment_input_1\"  id='payment_input_1_cf5c5f925d5558aedfa51ad74c95c9de'> <span class='ff_plan_title'>Back Cover (Inside) : 20,000<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_1_4503ecf1b96cef8678a48f24edec85a7><input type=\"radio\" name=\"payment_input_1\" data-name=\"payment_input_1\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item\" value=\"Back Cover (Outside) : 30,000\" data-payment_value=\"30000\" data-calc_value=\"30000\" data-group_id=\"ff_3_payment_input_1\"  id='payment_input_1_4503ecf1b96cef8678a48f24edec85a7'> <span class='ff_plan_title'>Back Cover (Outside) : 30,000<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_1_12daa3f0096964c845cf4d91fd30630b><input type=\"radio\" name=\"payment_input_1\" data-name=\"payment_input_1\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item\" value=\"Prestige Page : 10,000\" data-payment_value=\"10000\" data-calc_value=\"10000\" data-group_id=\"ff_3_payment_input_1\"  id='payment_input_1_12daa3f0096964c845cf4d91fd30630b'> <span class='ff_plan_title'>Prestige Page : 10,000<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_1_62f7e2e43d16fc5e87201ec4d76c70e1><input type=\"radio\" name=\"payment_input_1\" data-name=\"payment_input_1\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item\" value=\"Full Page : 8,000\" data-payment_value=\"8000\" data-calc_value=\"8000\" data-group_id=\"ff_3_payment_input_1\"  id='payment_input_1_62f7e2e43d16fc5e87201ec4d76c70e1'> <span class='ff_plan_title'>Full Page : 8,000<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_1_6edf6887ae0f5a9202559465ac985e3b><input type=\"radio\" name=\"payment_input_1\" data-name=\"payment_input_1\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item\" value=\"Half Page : 5,000\" data-payment_value=\"5000\" data-calc_value=\"5000\" data-group_id=\"ff_3_payment_input_1\"  id='payment_input_1_6edf6887ae0f5a9202559465ac985e3b'> <span class='ff_plan_title'>Half Page : 5,000<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=payment_input_1_904ce3ac94fd1088448ab2d9a44ba583><input type=\"radio\" name=\"payment_input_1\" data-name=\"payment_input_1\" class=\"ff-el-form-check-input ff-el-form-check-radio ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item ff_payment_item\" value=\"Quarter Page : 3,000\" data-payment_value=\"3000\" data-calc_value=\"3000\" data-group_id=\"ff_3_payment_input_1\"  id='payment_input_1_904ce3ac94fd1088448ab2d9a44ba583'> <span class='ff_plan_title'>Quarter Page : 3,000<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_3_item-quantity_1'>Quantity<\/label> <\/div><div class='ff-el-input--content'><input type=\"number\" name=\"item-quantity_1\" id=\"ff_3_item-quantity_1\" class=\"ff-el-form-control  ff_quantity_item\" data-quantity_item=\"yes\" data-name=\"item-quantity_1\" data-target_product=\"payment_input_1\" ><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_6\"  class='ff-t-container ff-column-container ff_columns_total_3  '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 34%;'><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 34%;'><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 34%;'><div class='ff-el-group has-conditions'><div class='ff-el-input--label asterisk-right'><label for='ff_3_custom-payment-amount'>Donation Amount<\/label> <\/div><div class='ff-el-input--content'><input type=\"number\" name=\"custom-payment-amount\" id=\"ff_3_custom-payment-amount\" class=\"ff-el-form-control  ff_payment_item\" data-payment_item=\"yes\" data-name=\"custom-payment-amount\" inputmode=\"decimal\" step=\"any\" ><\/div><\/div><\/div><\/div><div class='ff-el-group  ff-payment_summary_component' data-name=\"payment_summary_component-3_8\" ><div class=\"ff_dynamic_value ff_dynamic_payment_summary\" data-ref=\"payment_summary\"><div class=\"ff_payment_summary\"><\/div><div class=\"ff_payment_summary_fallback\"><\/div><\/div><\/div><div class='ff-el-group   has-conditions  ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label class='ff-el-form-check-label ff_tc_label' for=terms-n-condition_0a9048a6d07806b2c09a2f3a24741c1b><span class='ff_tc_checkbox'><input type=\"checkbox\" name=\"terms-n-condition\" class=\"ff-el-form-check-input\" data-name=\"terms-n-condition\" id=\"terms-n-condition_0a9048a6d07806b2c09a2f3a24741c1b\"  value='on'><\/span> <div class='ff_t_c'><p>I have read and agree to the <a href=\"#\" target=\"_blank\" rel=\"noopener\">Terms and Conditions<\/a> and <a href=\"#\" target=\"_blank\" rel=\"noopener\">Privacy Policy<\/a><\/p>\n<p><strong>Overall Size of Souvenir 24.5 cm x 18.5 cm,\u00a0Printed Are 21 cm x 15 cm<\/strong><\/p><\/div><\/label><\/div><\/div><div data-name=\"ff_cn_id_7\"  class='ff-t-container ff-column-container ff_columns_total_3  '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 34%;'><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 34%;'><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 34%;'><div class='ff-el-group'><div class='ff-el-input--label asterisk-right'><label >Payment Method<\/label> <\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-payment-method-label'><label class='ff-el-form-check-label' for=payment_method_8915bec9b58cf8402515b3f68c075f93><input name=\"payment_method\" type=\"radio\" data-name=\"payment_method\" class=\"ff-el-form-check-input ff_payment_method\" value=\"stripe\"  id='payment_method_8915bec9b58cf8402515b3f68c075f93'> <span>Pay with Debit\/Credit Card <\/span><\/label><\/div><div class='ff-el-form-check ff-el-payment-method-label'><label class='ff-el-form-check-label' for=payment_method_8df05eede42ea8762d981da8c9998451><input name=\"payment_method\" type=\"radio\" data-name=\"payment_method\" class=\"ff-el-form-check-input ff_payment_method\" value=\"test\"  id='payment_method_8df05eede42ea8762d981da8c9998451'> <span>Cash<\/span><\/label><\/div><\/div><\/div><\/div><\/div>        <div class=\"ff-step-t-container ff-inner_submit_container ff-column-container ff_columns_total_2\">\n            <div class=\"ff-t-cell ff-t-column-1\"><div class='step-nav ff_step_nav_last'><button  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary'>Previous<\/button><\/div><\/div>\n            <div class=\"ff-t-cell ff-t-column-2\"><div class='ff-el-group ff-text-left ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style\" >Submit Form <span class=\"ff_order_total\"><\/span><\/button><\/div><\/div>\n        <\/div>\n        <\/div><\/div><\/div>\n        <\/form><div id='fluentform_3_errors' class='ff-errors-in-stack ff_form_instance_3_1 ff-form-loading_errors ff_form_instance_3_1_errors'><\/div><\/div>        <script type=\"text\/javascript\">\n            window.fluent_form_ff_form_instance_3_1 = {\"id\":\"3\",\"settings\":{\"layout\":{\"labelPlacement\":\"top\",\"helpMessagePlacement\":\"with_label\",\"errorMessagePlacement\":\"inline\",\"asteriskPlacement\":\"asterisk-right\"},\"restrictions\":{\"denyEmptySubmission\":{\"enabled\":false}}},\"form_instance\":\"ff_form_instance_3_1\",\"form_id_selector\":\"fluentform_3\",\"rules\":{\"input_text\":{\"required\":{\"value\":true,\"message\":\"This field is required\"}},\"email\":{\"required\":{\"value\":true,\"message\":\"This field is required\"},\"email\":{\"value\":true,\"message\":\"This field must contain a valid email\"}},\"phone\":{\"required\":{\"value\":true,\"message\":\"This field is required\"},\"valid_phone_number\":{\"value\":false,\"message\":\"Phone number is not valid\"}},\"dropdown_2\":{\"required\":{\"value\":true,\"message\":\"This field is required\"}},\"input_text_1\":{\"required\":{\"value\":true,\"message\":\"This field is required\"}},\"email_1\":{\"required\":{\"value\":true,\"message\":\"This field is required\"},\"email\":{\"value\":true,\"message\":\"This field must contain a valid email\"}},\"phone_1\":{\"required\":{\"value\":true,\"message\":\"This field is required\"},\"valid_phone_number\":{\"value\":false,\"message\":\"Phone number is not valid\"}},\"dropdown\":{\"required\":{\"value\":false,\"message\":\"This field is required\"}},\"image-upload\":{\"required\":{\"value\":false,\"message\":\"This field is required\"},\"max_file_size\":{\"value\":4194304,\"_valueFrom\":\"MB\",\"message\":\"Maximum file size limit is 4MB\"},\"max_file_count\":{\"value\":1,\"message\":\"You can upload maximum 1 image\"},\"allowed_image_types\":{\"value\":[\"jpg|jpeg\",\"png\"],\"message\":\"Only jpg and png supported\"}},\"description\":{\"required\":{\"value\":false,\"message\":\"This field is required\"}},\"dropdown_1\":{\"required\":{\"value\":false,\"message\":\"This field is required\"}},\"payment_input\":{\"required\":{\"value\":true,\"message\":\"This field is required\"}},\"item-quantity\":{\"required\":{\"value\":true,\"message\":\"This field is required\"},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\"},\"min\":{\"value\":\"\",\"message\":\"Minimum value is \"},\"max\":{\"value\":\"\",\"message\":\"Maximum value is \"}},\"payment_input_1\":{\"required\":{\"value\":true,\"message\":\"This field is required\"}},\"item-quantity_1\":{\"required\":{\"value\":true,\"message\":\"This field is required\"},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\"},\"min\":{\"value\":\"\",\"message\":\"Minimum value is \"},\"max\":{\"value\":\"\",\"message\":\"Maximum value is 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