Payment/Donation Form

Payment/Donation Form

Five Hearts
Full Name*

First NameLast Name
Business Name (if applicable):
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Phone Number*
Type of Donation*

Horse Therapy Lesson ~ $30-$40One Time DonationMonthly SponsorshipSponsor a Student (Indicate in comments the student you are sponsoring)
Comments
Donation Amount*

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Thank you for your payment/donation to Five Hearts Therapeutic Horsemanship. These funds allow us to continue our successful programs in Equine Assisted Therapy for the special needs community.

Tax ID Number: 86-2700513

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Payment Methods

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Choose from one of the PayPal options to make your payment.