{"id":2135,"date":"2020-09-28T15:12:37","date_gmt":"2020-09-28T19:12:37","guid":{"rendered":"https:\/\/www.bu.edu\/card\/?page_id=2135"},"modified":"2022-10-28T10:52:14","modified_gmt":"2022-10-28T14:52:14","slug":"online-payments","status":"publish","type":"page","link":"https:\/\/www.bu.edu\/card\/online-payments\/","title":{"rendered":"Online Payments"},"content":{"rendered":"<link rel='stylesheet' id='gforms_reset_css-css'  href='https:\/\/www.bu.edu\/card\/wp-content\/plugins\/gravityforms\/css\/formreset.min.css?ver=2.4.17' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='gforms_formsmain_css-css'  href='https:\/\/www.bu.edu\/card\/wp-content\/plugins\/gravityforms\/css\/formsmain.min.css?ver=2.4.17' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='gforms_ready_class_css-css'  href='https:\/\/www.bu.edu\/card\/wp-content\/plugins\/gravityforms\/css\/readyclass.min.css?ver=2.4.17' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='gforms_browsers_css-css'  href='https:\/\/www.bu.edu\/card\/wp-content\/plugins\/gravityforms\/css\/browsers.min.css?ver=2.4.17' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='bu_gforms-css'  href='https:\/\/www.bu.edu\/card\/wp-content\/mu-plugins\/bu-gf-customizations\/css\/bu_base_gf.css?ver=BU-0.6.13' type='text\/css' media='all' \/>\n<script type='text\/javascript' src='https:\/\/www.bu.edu\/card\/wp-includes\/js\/jquery\/jquery.js?ver=1.12.4-wp'><\/script><br \/>\n<script type='text\/javascript' src='https:\/\/www.bu.edu\/card\/wp-includes\/js\/jquery\/jquery-migrate.min.js?ver=1.4.1'><\/script><br \/>\n<script type='text\/javascript' src='https:\/\/www.bu.edu\/card\/wp-content\/themes\/responsive-framework\/js\/vendor\/modernizer.min.js?ver=2.8.3'><\/script><\/p>\n<div class='gform_wrapper' id='gform_wrapper_nutrition' >\n<form method='post' enctype='multipart\/form-data'  id='gform_card'  action=\"https:\/\/www.bu.edu\/phpbin\/marconi\/\" accept-charset=\"UTF-8\">\n    <input name=\"form_id\" id=\"form_id\" value=\"card\" type=\"hidden\" \/><\/p>\n<div class='gform_heading'>\n<h3 class='gform_title'>CARD &#8211; Online Payments<\/h3>\n<p><span class='gform_description'>Dear Patients,<\/p>\n<p>        In order to credit your payment appropriately, please provide the information below. Thank you! <\/span><\/p>\n<\/p><\/div>\n<div class='gform_body'>\n<ul id='gform_fields_nutrition' class='gform_fields top_label form_sublabel_below description_below'>\n<li id='field_name' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' >\n          <label class='gfield_label gfield_label_before_complex'  >Name of Payer<span class='gfield_required'>*<\/span><\/label><\/p>\n<div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gfield_trigger_change' id='input_name'> <span id='firstname_container' class='name_first' ><br \/>\n            <input type='text' name='firstname' id='firstname' value='' aria-label='Payer First name'  aria-required=\"true\" aria-invalid=\"false\" \/><br \/>\n            <label for='firstname' >First<\/label><br \/>\n            <\/span> <span id='lastname_container' class='name_last' ><br \/>\n            <input type='text' name='lastname' id='lastname' value='' aria-label='Payer Last name'  aria-required=\"true\" aria-invalid=\"false\" \/><br \/>\n            <label for='lastname' >Last<\/label><br \/>\n            <\/span> <\/div>\n<\/li>\n<li id='field_email' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' >\n          <label class='gfield_label' for='email' >Payer Email<span class='gfield_required'>*<\/span><\/label><\/p>\n<div class='ginput_container ginput_container_email'>\n            <input name='email' id='email' type='email' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"\/>\n          <\/div>\n<\/li>\n<li id='field_payment_amount' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' >\n          <label class='gfield_label' for='payment_amount' >Payment Amount in USD $<span class='gfield_required'>*<\/span><\/label><\/p>\n<div class='ginput_container ginput_container_number'>\n            <input name='payment_amount' id='payment_amount' type='text'  placeholder=\"0.00\"  value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"\/>\n          <\/div>\n<\/li>\n<li id='field_patient_name' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' >\n          <label class='gfield_label gfield_label_before_complex'  >Name of Patient<span class='gfield_required'>*<\/span><\/label><\/p>\n<div class='ginput_container ginput_container_radio'>\n<ul class='gfield_radio' id='shipping_billing_same'>\n<li class='gchoice_radiobut_1'>\n                <label><br \/>\n                  <input id=\"sameas\" name=\"sameas\" type=\"checkbox\" value=\"Patient Name Same as Payer Name\"  onclick=\"sameAsAbove()\" \/><br \/>\n                  <span class=\"radiodiv\">Same as &quot;Name of Payer&quot; above<\/span><\/label>\n              <\/li>\n<\/ul><\/div>\n<div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gfield_trigger_change' id='input_patient_name'> <span id='patient_firstname_container' class='name_first' ><br \/>\n            <input type='text' name='patient_firstname' id='patient_firstname' value='' aria-label='Patient First name'  aria-required=\"false\" aria-invalid=\"false\" \/><br \/>\n            <label for='patient_firstname' >First<\/label><br \/>\n            <\/span> <span id='patient_lastname_container' class='patient_name_last' ><br \/>\n            <input type='text' name='patient_lastname' id='patient_lastname' value='' aria-label='Patient Last name'  aria-required=\"false\" aria-invalid=\"false\" \/><br \/>\n            <label for='patient_lastname' >Last<\/label><br \/>\n            <\/span> <\/div>\n<\/li>\n<li id='field_phone' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' >\n          <label class='gfield_label' for='phone' >Patient Phone Number<span class='gfield_required'>*<\/span><\/label><\/p>\n<div class='ginput_container ginput_container_text'>\n            <input name='phone' id='phone' type='text' value='' class='medium'  aria-required=\"true\" aria-invalid=\"false\" \/>\n          <\/div>\n<\/li>\n<\/ul><\/div>\n<div>\n<p><strong>Refund Policy:<\/strong> Over-payments will be reviewed and remediated as soon as possible.<\/p>\n<p>Please verify that the information is correct above and then press <strong>Submit<\/strong> and you will proceed to the secure Nelnet Payment form where you can enter your credit card information.<\/p>\n<\/p><\/div>\n<div class='gform_footer top_label'>\n      <input type='submit' id='gform_submit_button_nutrition' class='gform_button button' value='Submit' \/>\n    <\/div>\n<\/p><\/form>\n<\/div>\n<p><script src=\"http:\/\/ajax.googleapis.com\/ajax\/libs\/jquery\/1.4.2\/jquery.min.js\">\r\n    <\/script><\/p>\n<pre style=\"display:none\"><script>\r\n    function sameAsAbove() {\r\n        if ($('#sameas').is(\":checked\")) {\r\n            $(\"#patient_firstname\").val($(\"#firstname\").val());\r\n            $(\"#patient_lastname\").val($(\"#lastname\").val());\r\n        } else {\r\n            $(\"#patient_firstname\").val('');\r\n            $(\"#patient_lastname\").val('');\r\n        }\r\n    }\r\n<\/script><\/pre>\n","protected":false},"excerpt":{"rendered":"<p>CARD &#8211; Online Payments Dear Patients, In order to credit your payment appropriately, please provide the information below. Thank you! Name of Payer* First Last Payer Email* Payment Amount in USD $* Name of Patient* Same as &quot;Name of Payer&quot; above First Last Patient Phone Number* Refund Policy: Over-payments will be reviewed and remediated as [&hellip;]<\/p>\n","protected":false},"author":1251,"featured_media":0,"parent":0,"menu_order":10,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/www.bu.edu\/card\/wp-json\/wp\/v2\/pages\/2135"}],"collection":[{"href":"https:\/\/www.bu.edu\/card\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.bu.edu\/card\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/card\/wp-json\/wp\/v2\/users\/1251"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/card\/wp-json\/wp\/v2\/comments?post=2135"}],"version-history":[{"count":4,"href":"https:\/\/www.bu.edu\/card\/wp-json\/wp\/v2\/pages\/2135\/revisions"}],"predecessor-version":[{"id":2812,"href":"https:\/\/www.bu.edu\/card\/wp-json\/wp\/v2\/pages\/2135\/revisions\/2812"}],"wp:attachment":[{"href":"https:\/\/www.bu.edu\/card\/wp-json\/wp\/v2\/media?parent=2135"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}