Payment/Donation Form
Five Hearts Therapeutic Horsemanship
Full Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Type of Donation
*
Horse Therapy Lesson ~ $30-$40
One Time Donation
Monthly Sponsorship
Sponsor a Student
Sponsor a Horse
Comments
*
Donation Amount
*
prev
next
( X )
USD
Please enter your donation amount
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
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