{"id":1647,"date":"2026-02-27T23:30:51","date_gmt":"2026-02-27T23:30:51","guid":{"rendered":"https:\/\/www.armorfenceco.com\/va-payment\/?page_id=1647"},"modified":"2026-03-02T18:36:29","modified_gmt":"2026-03-02T18:36:29","slug":"payment-page","status":"publish","type":"page","link":"https:\/\/www.armorfenceco.com\/va-payment\/payment-page\/","title":{"rendered":"armorfencenew"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background hundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:0px;--awb-padding-right:0px;--awb-padding-bottom:0px;--awb-padding-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-stretch fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-padding-top:60px;--awb-padding-right:60px;--awb-padding-bottom:60px;--awb-padding-left:60px;--awb-padding-top-small:40px;--awb-padding-right-small:20px;--awb-padding-bottom-small:40px;--awb-padding-left-small:20px;--awb-bg-color:var(--awb-color1);--awb-bg-color-hover:var(--awb-color1);--awb-bg-size:cover;--awb-width-large:33.3333333333%;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:5.76%;--awb-width-medium:33.3333333333%;--awb-order-medium:0;--awb-spacing-right-medium:5.76%;--awb-spacing-left-medium:5.76%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\" data-scroll-devices=\"small-visibility,medium-visibility,large-visibility\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-image-element \" style=\"--awb-margin-bottom:20px;--awb-max-width:250px;--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-1 hover-type-none\"><a class=\"fusion-no-lightbox\" href=\"https:\/\/www.armorfenceco.com\/va-payment\/payment-page\/\" target=\"_self\" aria-label=\"logo\"><img decoding=\"async\" width=\"169\" height=\"92\" src=\"https:\/\/www.armorfenceco.com\/va-payment\/wp-content\/uploads\/sites\/3\/2026\/02\/logo.png\" alt class=\"img-responsive wp-image-1634\"\/><\/a><\/span><\/div><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-text fusion-title-size-four\" style=\"--awb-margin-top:0px;--awb-margin-bottom:0px;--awb-margin-top-small:0px;--awb-margin-bottom-small:0px;\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Payment Portal<\/h4><\/div><div class=\"fusion-text fusion-text-1\"><p>Virginia<\/p>\n<\/div><div class=\"fusion-image-element \" style=\"--awb-max-width:250px;--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-2 hover-type-none\"><img decoding=\"async\" width=\"1920\" height=\"820\" title=\"AdobeStock_1586256016\" src=\"https:\/\/www.armorfenceco.com\/va-payment\/wp-content\/uploads\/sites\/3\/2025\/12\/AdobeStock_1586256016.png\" alt class=\"img-responsive wp-image-1612\" srcset=\"https:\/\/www.armorfenceco.com\/va-payment\/wp-content\/uploads\/sites\/3\/2025\/12\/AdobeStock_1586256016-300x128.png 300w, https:\/\/www.armorfenceco.com\/va-payment\/wp-content\/uploads\/sites\/3\/2025\/12\/AdobeStock_1586256016-768x328.png 768w, https:\/\/www.armorfenceco.com\/va-payment\/wp-content\/uploads\/sites\/3\/2025\/12\/AdobeStock_1586256016-1024x437.png 1024w, https:\/\/www.armorfenceco.com\/va-payment\/wp-content\/uploads\/sites\/3\/2025\/12\/AdobeStock_1586256016-1536x656.png 1536w, https:\/\/www.armorfenceco.com\/va-payment\/wp-content\/uploads\/sites\/3\/2025\/12\/AdobeStock_1586256016.png 1920w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/span><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_2_3 2_3 fusion-flex-column\" style=\"--awb-padding-top:60px;--awb-padding-right:60px;--awb-padding-bottom:60px;--awb-padding-left:60px;--awb-padding-top-small:40px;--awb-padding-right-small:20px;--awb-padding-bottom-small:40px;--awb-padding-left-small:20px;--awb-bg-color:var(--awb-color2);--awb-bg-color-hover:var(--awb-color2);--awb-bg-size:cover;--awb-width-large:66.6666666667%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.88%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:2.88%;--awb-width-medium:66.6666666667%;--awb-order-medium:0;--awb-spacing-right-medium:2.88%;--awb-spacing-left-medium:2.88%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\" data-scroll-devices=\"small-visibility,medium-visibility,large-visibility\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-text fusion-title-size-one\"><h1 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Payment Page<\/h1><\/div><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_4' style='display:none'>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_4'  action='\/va-payment\/wp-json\/wp\/v2\/pages\/1647' data-formid='4' novalidate> \r\n <input type='hidden' class='gforms-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n                        <div class='gform-body gform_body'><div id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_4_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><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_4_1'>\n                            \n                            <span id='input_4_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_4_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_4_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_4_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_4_3\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_3'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_4_3' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_4\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_4'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_4' id='input_4_4' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_4_12\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Project Property Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_4_12' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_12_1_container' >\n                                        <input type='text' name='input_12.1' id='input_4_12_1' value=''    aria-required='true'    \/>\n                                        <label for='input_4_12_1' id='input_4_12_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_4_12_3_container' >\n                                    <input type='text' name='input_12.3' id='input_4_12_3' value=''    aria-required='true'    \/>\n                                    <label for='input_4_12_3' id='input_4_12_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_4_12_4_container' >\n                                        <input type='text' name='input_12.4' id='input_4_12_4' value=''      aria-required='true'    \/>\n                                        <label for='input_4_12_4' id='input_4_12_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_4_12_5_container' >\n                                    <input type='text' name='input_12.5' id='input_4_12_5' value=''    aria-required='true'    \/>\n                                    <label for='input_4_12_5' id='input_4_12_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_12.6' id='input_4_12_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_4_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Choose a Payment Option<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_13'>\n\t\t\t<div class='gchoice gchoice_4_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Credit Card - A 3% credit card surcharge is applied to all credit card transactions. This fee is not greater than our cost of acceptance.'  id='choice_4_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_13_0' id='label_4_13_0' class='gform-field-label gform-field-label--type-inline'>Credit Card - A 3% credit card surcharge is applied to all credit card transactions. This fee is not greater than our cost of acceptance.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='ACH (eCheck)'  id='choice_4_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_13_1' id='label_4_13_1' class='gform-field-label gform-field-label--type-inline'>ACH (eCheck)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_14\" class=\"gfield gfield--type-ach gfield--input-type-ach gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >ACH (eCheck)<\/legend><div class='ginput_complex ginput_container ginput_container_ach gform-grid-row' id='input_4_14'><span class='ginput_left ginput_address_city  gform-grid-col' id='input_4_14_1_container' >\r\n\t\t\t\t\t\t\t\t\t<input type='text' name='input_14.1' id='input_4_14_1' value=''     autocomplete='off' pattern='[0-9]*' title='Only digits are allowed'  aria-required='false'  \/>\r\n\t\t\t\t\t\t\t\t\t<label for='input_4_14_1' id='input_4_14_1_label' class='gform-field-label gform-field-label--type-sub '>Account Number<\/label>\r\n\t\t\t\t\t\t\t\t <\/span><span class='ginput_right ginput_address_country gform-grid-col' id='input_4_14_3_container'>\r\n                                    <select name='input_14.3' id='input_4_14_3'   class='ginput_card_expiration' aria-required='false'  >\r\n\t\t\t\t\t\t\t\t\t\t<option value=''>Select<\/option><option value='S' >Savings<\/option><option value='C' >Checking<\/option>\r\n\t\t\t\t\t\t\t\t\t<\/select>\r\n                                    <label for='input_4_14_3' id='input_4_14_3_label' class='gform-field-label gform-field-label--type-sub '>Account Type<\/label>\r\n                                 <\/span><span class='ginput_full gform-grid-col' id='input_4_14_2_container' >\r\n                                    <input type='text' name='input_14.2' id='input_4_14_2' value=''     autocomplete='off' pattern='[0-9]*' title='Only digits are allowed'  aria-required='false'  \/>\r\n                                    <label for='input_4_14_2' id='input_4_14_2_label' class='gform-field-label gform-field-label--type-sub '>Routing Number<\/label>\r\n                                 <\/span><span class='ginput_full gform-grid-col' id='input_4_14_4_container'>\r\n                                            <input type='text' name='input_14.4' id='input_4_14_4' value=''    aria-required='false'  \/>\r\n                                            <label for='input_4_14_4' id='input_4_14_4_label' class='gform-field-label gform-field-label--type-sub '>Account Holder Name<\/label>\r\n                                        <\/span> <\/div><\/fieldset><fieldset id=\"field_4_7\" class=\"gfield gfield--type-creditcard gfield--input-type-creditcard gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Credit Card<\/legend><div class='ginput_complex ginput_container ginput_container_creditcard gform-grid-row' id='input_4_7'><span class='ginput_full gform-grid-col' id='input_4_7_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_4_7_supported_creditcards'>Supported Credit Cards: American Express, Discover, MasterCard, Visa<\/span><\/div>\n                                    <input type='text' name='input_7.1' id='input_4_7_1' value=''   onchange='gformMatchCard(\"input_4_7_1\");' onkeyup='gformMatchCard(\"input_4_7_1\");' autocomplete='off' pattern='[0-9]*' title='Only digits are allowed'  aria-required='false'  \/>\n                                    <label for='input_4_7_1' id='input_4_7_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_4_7_2_container'>\n                                            <fieldset class='ginput_cardinfo_left gform-grid-col' id='input_4_7_2_cardinfo_left'>\n                                            <legend class='gform-field-label gform-field-label--type-sub '>Expiration Date<\/legend>\n                                                <span class='ginput_card_expiration_container ginput_card_field gform-grid-row'>\n                                                   <span class='ginput_card_expiration_month_container gform-grid-col'>\n                                                       <label for='input_4_7_2_month' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                                       <select name='input_7.2[]' id='input_4_7_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                                                   <\/span>\n                                                   <span class='ginput_card_expiration_year_container gform-grid-col'>\n                                                       <label for='input_4_7_2_year' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                                       <select name='input_7.2[]' id='input_4_7_2_year'   class='ginput_card_expiration ginput_card_expiration_year' aria-required='false'  >\n                                                           <option value=''>Year<\/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><option value='2044' >2044<\/option><option value='2045' >2045<\/option>\n                                                       <\/select>\n                                                   <\/span>\n                                                <\/span>\n                                            <\/fieldset><span class='ginput_cardinfo_right gform-grid-col' id='input_4_7_2_cardinfo_right'>\n                                                <input type='text' name='input_7.3' id='input_4_7_3'   class='ginput_card_security_code' value='' autocomplete='off' pattern='[0-9]*' title='Only digits are allowed'  aria-required='false'  \/>\n                                                <span class='ginput_card_security_code_icon'>&nbsp;<\/span>\n                                                <label for='input_4_7_3' class='gform-field-label gform-field-label--type-sub '>Security Code<\/label>\n                                             <\/span>\n                                        <\/span><span class='ginput_full gform-grid-col' id='input_4_7_5_container'>\n                                            <input type='text' name='input_7.5' id='input_4_7_5' value=''    aria-required='false'  \/>\n                                            <label for='input_4_7_5' id='input_4_7_5_label' class='gform-field-label gform-field-label--type-sub '>Cardholder Name<\/label>\n                                        <\/span> <\/div><\/fieldset><fieldset id=\"field_4_15\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Billing Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_4_15' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_15_1_container' >\n                                        <input type='text' name='input_15.1' id='input_4_15_1' value=''    aria-required='true'    \/>\n                                        <label for='input_4_15_1' id='input_4_15_1_label' class='gform-field-label gform-field-label--type-sub '>Billing Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_4_15_3_container' >\n                                    <input type='text' name='input_15.3' id='input_4_15_3' value=''    aria-required='true'    \/>\n                                    <label for='input_4_15_3' id='input_4_15_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_4_15_4_container' >\n                                        <input type='text' name='input_15.4' id='input_4_15_4' value=''      aria-required='true'    \/>\n                                        <label for='input_4_15_4' id='input_4_15_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_4_15_5_container' >\n                                    <input type='text' name='input_15.5' id='input_4_15_5' value=''    aria-required='true'    \/>\n                                    <label for='input_4_15_5' id='input_4_15_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_15.6' id='input_4_15_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_9\" class=\"gfield gfield--type-product gfield--input-type-price gfield--width-full gfield_price gfield_price_4_9 gfield_product_4_9 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_9'>Amount<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_product_price'>\n\t\t\t\t\t<input name='input_9' id='input_4_9' type='text' value='' class='large ginput_amount'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/div><div id=\"field_4_16\" class=\"gfield gfield--type-product gfield--input-type-calculation gfield--width-full gfield_price gfield_price_4_16 gfield_product_4_16 gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_4_16_1'>Processing Fee<\/label><div class='ginput_container ginput_container_product_calculation'>\n\t\t\t\t\t<input type='hidden' name='input_16.1' value='Processing Fee' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_4_16' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_4_16'>$0.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_16.2' id='ginput_base_price_4_16' class='gform_hidden ginput_calculated_price' value='$0.00'\/>\n\t\t\t\t\t<input type='hidden' name='input_16.3' value='1' class='ginput_quantity_4_16 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_4_11\" class=\"gfield gfield--type-total gfield--input-type-total gfield--width-full gfield_price gfield_price_4_ gfield_total gfield_total_4_ field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" ><label class='gfield_label gform-field-label' for='input_4_11'>Total<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<input type='text' readonly name='input_11' id='input_4_11' value='$0.00' class='gform-text-input-reset ginput_total ginput_total_4' \/>\n\t\t\t\t\t\t<\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_4' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_4' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_4' id='gform_theme_4' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_4' id='gform_style_settings_4' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_4' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='4' \/>\n            \n       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