Payment/Donation Form

Payment/Donation Form

Five Hearts Therapeutic Horsemanship
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*

prevnext( X )
USDPlease enter your donation amount
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

An email receipt will be sent to the email address you entered.

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.